Objective To explorer the safety of D2 lymphadenectomy in open distal gastrectomy for distal gastric cancer with the surgical approach from bottom to top,from left to right and from surrounding to middle.Methods 100 advanced distal gastric cancer patients selected from General Surgery Department of Chang Hai Hospital from December 2012 to November 2013 were analyzed retrospectively.All the patients were performed D2 lymphadenectomy in open distal gastrectomy with surgical approach from bottom to top,from left to right and from surrounding to middle.The operation time,amount of bleeding,the number of lymph nodes,postoperative complications and follow-up observation were recorded.Ruselts All patients had successful operation.The operation time was 90 to 190 mins,the average (125.00 ± 21.43) mins;intraoperative blood was 90 to 400 ml,the average (178.00 ± 73.74) ml;number of lymph node dissection was 17 to 41,the average (26.00 ± 6.72).One patient suffered from abdominal hemorrhage,recoverd and discharged after conservative treatment.Conclusions Surgical approach from bottom to top,from left to right and from surrounding to middle can improve the safety of D2 lymphadenectomy for distal gastric cancer.

ObjectiveTo investigate the efficacy of combined therapy of mild hypothermia and hibernation to treat severe brain injury. Methods24 patients with severe brain injury were randomly divided into combined therapy group and normothermia group. Glasgow Coma Scale scores of all the patients were in the range of 3 to 8. No later than 10 hours after their injury, hypothermia patients were given half dosage of No.1 hibernation cocktail and had been cooled by cooling blankets to 32℃-34℃ (rectal temperature) for 5 days, then to 35℃ for 24 hours, and slowly increased to their normal level. 3 days and 7 days after their admission, intracranial pressure,creatine phosphate kinase,partial pressure of arterial O2 and CO2, platelet and Na+,K+ were measured.7 days after their admission, Glasgow Outcome Scale scores of each patient and mortality of each group were measured. ResultsThe mortality of combined therapy group(25.0%) was significantly lower than that of normothermia group (66.6%,P<0.05). The decreased values of intracranial pressure, creatine phosphate kinase and platelet number of combined therapy group were all significantly higher than that of normothermia group respectively (P<0.05). There were no significant difference in mean artery pressure, blood electrolyte, and partial pressure of arterial O2 and CO2 between these two groups(P>0.05). ConclusionThe combined therapy of mild hypothermia and hibernation can effectively reduce the mortality of patients with severe brain injury as it is much easier, less invasive and with less complications.

Objective:To explore the clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator (DIEP) flap in breast reconstruction.Methods:A retrospective observational study was used. From December 2008 to December 2016, 24 patients who met the inclusion criteria were treated in the Department of Plastic Surgery of Hunan Cancer Hospital, all patients were female, aged 28-51 (36.5±1.6) years. All cases received turbocharged bipedicle DIEP flap for two-staged breast reconstruction. According to the patterns of turbocharged vessels anastomosis, the turbocharged bipedicle DIEP flaps with length of (27.5±0.3) cm and width of (12.8±1.4) cm, were divided into three types: distal end of pedicle anastomosis type, main branch of pedicle anastomosis type, and muscular branch of pedicle anastomosis type. After complete hemostasis in the donor region, the anterior sheath was repaired with intermittent suture, and umbilical reconstruction was completed. Two negative pressure drainage tubes were indwelled, and subcutaneous tissue and skin were sutured layer by layer. The specific ways of vascular anastomosis of the flap pedicle with the internal thoracic vessels of recipient site included anastomosing the proximal end of one artery and one vein, anastomosing the proximal and distal end of one artery and one vein, and anastomosing the proximal end of one artery and two veins. Postoperatively, the survival and blood supply of flaps were observed. The patients were followed up to observe the reconstructed breast shape satisfaction, donor site complications, abdominal wall function, and scar hyperplasia.Results:All turbocharged bipedicle DIEP flaps for two-staged breast reconstruction survived well, with good blood supply. During follow-up for 14 to 56 (20±6) months, the shape of reconstructed breasts was satisfied. Only linear scar was left in the donor sites of abdomen with no complications, and the function of abdominal wall was not affected.Conclusions:For patients with clear indications, transplantation of free turbocharged bipedicle DIEP flap is a safe, reliable, and satisfactory choice for breast reconstruction with autologous tissue.

Objective To explore the application of various forms of anterolateral thigh flap in lower extremity and ankle amputation with extensive skin and soft tissue defect reconstruction.Methods From September 2011 to December 2015,26 cases of lower extremity and ankle amputation with extensive skin and soft tissue defect reconstruction (included 20 male patients and 6 female patients) were admitted,the age ranged from 22 to 61 years old (38.6 ± 4.5).Among these cases,10 cases received flow-through anterolateral thigh flap,16 cases used chimeric anterolateral thigh flap with vastus lateralis thigh muscle flap,15 flaps were thinned in one-staged,5 flaps were harvested in double-paddled form.The flap size ranged from 10 cm × 6 cm to 28 cm × 12 cm.The donor site was closed directly in all cases.Results All flaps and replanted extremities survived uneventfully.All patients were followed up for 8 to 30 months with satisfied esthetic and functional results in reconstructed foot and ankle,the texture of flaps was good,no bulky was noted and no second revision was needed.No local ulcer happened and regained protective sensation.Only linear scar left in the donor sites,no hernia occurred.Conclusions Various forms of anterolateral thigh flap is the effective choice in lower extremity and ankle amputation with extensive skin and soft tissue defect reconstruction.