Objective To investigate the safety and efficacy of laparoscopy-assisted D2 radical gastrectomy in the treatment of advanced gastric cancer.Methods From March 2011 to March 2016,one hundred and four cases treated with LAG for advanced gastric cancer in the general surgery department of Gaochun District People Hospital of Nanjing and the 251st Hospital of PLA were collected in the laparoscope group,104)and 101 cases undergoing gastric cancer surgery from the same period were selected as the control group(open surgery group).A retrospective analysis was performed between the two groups in operation time, intraoperative blood loss, postoperative eating time, ambulation time, exhaust time, postoperative fever, postoperative analgesic use,hospitalization time,postoperative complications,the proximal and distal margins and the number of lymph node dissection.Results The operation time was significantly longer in the LAG group than in the open surgery group(311.2 ± 28.9)min vs.(157.38 ± 11.9)min,t=2.899,P<0.01).The intraoperative blood loss in the laparoscope group was less than that in the open surgery group((100.3±12.1) ml vs.(200.6±16.3)ml,t=3.014,P<0.01).In addition,the frequency of postoperative analgesia,the first postoperative exhaust time,the first postoperative eating time and the postoperative hospital stay in the laparoscopic group were better than those in the open surgery group(P<0.05).There was no significant difference in the number of lymph node dissection and postoperative complication between the two groups(P=0.264,P=0.575).The survival analysis showed that the overall survival rate in the two groups was equivalent at 6 years after surgery(P=0.623).Conclusion Laparoscopy-assisted radical gastrectomy for advanced gastric cancer is safe and feasible,with acceptable long-term results,and shows better performance in the near future.

Objective To evaluate carotid sinus block (CAS) in preventing the low hemodynamic state in the perioperative period of carotid artery stenting (CAS).Method A prospective single-center randomized controlled study was conducted on 172 patients with internal carotid artery stenosis receiving CAS from May 2015 to May 2018.Patients were randomly divided into group A treated with local anesthesia of the carotid artery sinus of the trouble side under the guidance of ultrasound preoperatively and group B without local block anesthesia.The carotid artery stenosis rate,the maximum intraoperative reduction of blood pressure and heart rate,the use of atropine and vasopressor were monitored and compared between the two groups.Results There were no significant differences between the two groups in preoperative general data,degree of stenosis,plaque nature,degree of residual stenosis (P ＞ 0.05).The maximum reduction of intraoperative blood pressure and heart rate in group A was significantly lower than that in group B,and the number and dose of intraoperative atropine were smaller than those in group B (P ＜ 0.05).The number of postoperative patients with low hemodynamic status in group A and the time period of vasopressor use were significantly less than those in group B (P ＜ 0.05).Conclusion Preoperative carotid sinus block anesthesia is safe and effective in preventing low hemodynamic status in perioperative period of CAS.

Objective To compare the clinical efficacy of laparoscopic wedge resection and open wedge resection in the treatment of gastrointestinal stromal tumor. Methods Fifty?five patients with gastrointestinal stromal tumor who underwent laparoscopic wedge resection and 61 cases underwent open wedge resection in Tongji Hospital from January 2009 to December 2014 were included into this study. The perioperative, surgical operative and postoperative data of the patients were documented and analyzed. Results The operation time of laparoscopic group was significantly shorter than that of the open group [(108.2±27.2) min versus (139.9±75.3) min, P=0.021], the amount of intraoperative blood loss was overtly reduced in the laparoscopic group [(57.1±48.7) ml versus (100.6±45.8) ml, P=0.011], the time to postoperative exhaust or defecation was (2.2±1.4) d in the laparoscopic group and (3.5±1.8) d in the open group (P=0.028), and the length of hospital stay was (5.7±1.3) d versus (6.9±2.1) d (P=0.044). There were intraoperative complication in one case and postoperative complications in 5 cases, while neither tumor rupture nor obvious perioperative complication was observed in the laparoscopic group. During the period of follow?up ( mean, 15.3 months) , only one case of replase occurred in the laparoscopic group while four cases of relapse were observed in the open group. Conclusions With experienced skills and to strictly comply with the surgical indications, laparoscopic wedge resection is prior to tranditional open wedge resection for the treatment of gastrointestinal stromal tumor. The laparoscopic wedge resection can achieve the standard of R0 resection, keep the resected tumor with an intact capsule, reduce the operating time and operative trauma, promote the postoperative recovery and get a better prognosis. Therefore, it is a feasible, safe, minimally invasive surgical procedure associated with a rapid postoperative recovery.

Objective To compare the clinical efficacy of laparoscopic wedge resection and open wedge resection in the treatment of gastrointestinal stromal tumor. Methods Fifty?five patients with gastrointestinal stromal tumor who underwent laparoscopic wedge resection and 61 cases underwent open wedge resection in Tongji Hospital from January 2009 to December 2014 were included into this study. The perioperative, surgical operative and postoperative data of the patients were documented and analyzed. Results The operation time of laparoscopic group was significantly shorter than that of the open group [(108.2±27.2) min versus (139.9±75.3) min, P=0.021], the amount of intraoperative blood loss was overtly reduced in the laparoscopic group [(57.1±48.7) ml versus (100.6±45.8) ml, P=0.011], the time to postoperative exhaust or defecation was (2.2±1.4) d in the laparoscopic group and (3.5±1.8) d in the open group (P=0.028), and the length of hospital stay was (5.7±1.3) d versus (6.9±2.1) d (P=0.044). There were intraoperative complication in one case and postoperative complications in 5 cases, while neither tumor rupture nor obvious perioperative complication was observed in the laparoscopic group. During the period of follow?up ( mean, 15.3 months) , only one case of replase occurred in the laparoscopic group while four cases of relapse were observed in the open group. Conclusions With experienced skills and to strictly comply with the surgical indications, laparoscopic wedge resection is prior to tranditional open wedge resection for the treatment of gastrointestinal stromal tumor. The laparoscopic wedge resection can achieve the standard of R0 resection, keep the resected tumor with an intact capsule, reduce the operating time and operative trauma, promote the postoperative recovery and get a better prognosis. Therefore, it is a feasible, safe, minimally invasive surgical procedure associated with a rapid postoperative recovery.