Laparoscopic D2 radical surgery for gastric cancer is minimally invasive but complex.In this path:(1) Repeated operation of lesser curvature side;(2) The gastrohepatic ligament is relatively fixed.Hence,it is not easy...Laparoscopic D2 radical surgery for gastric cancer is minimally invasive but complex.In this path:(1) Repeated operation of lesser curvature side;(2) The gastrohepatic ligament is relatively fixed.Hence,it is not easy to expose the suprapancreatic area;and(3) It is not easy to dissect No.1,12 lymph nodes.This area may not be sufficiently cleaned or surrounding vessels may be injured during a resection.So it is critical to choose position fixing,and a clear,fast and convenient operation path.The author,based on his experience,has established a set of procedural steps called "Gao's double-way",lesser omentum approach and traditional greater omentum approach,which are described in detail in this article.The path of this first approach is described as a "W" type of dissection.The second way is the traditional greater omentum approach,whose path is described as a "M" type of dissection.This will enable laparoscopic surgeons to select a suitable path.This new approach not only simplifies the surgery but also provides more space for the subsequent operation,thereby making the surgery more simple,safe and easy.展开更多
Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection(DSWI) following median sternotomy. Methods Between January ...Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection(DSWI) following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males(73.7%) and 5 females(26.3%), aged 55±13(18-78) years. According to the Pairolero classification of infected median sternotomies, 3(15.8%) patients were type II, and the other 16(84.2%) were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients(78.9%), bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients(21.0%) needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients(10.5%) presented with subcutaneous infection, and 3 patients(15.8%) had hematoma. They recovered following local debridement and medication. 17 patients(89.5%) were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.展开更多
文摘Laparoscopic D2 radical surgery for gastric cancer is minimally invasive but complex.In this path:(1) Repeated operation of lesser curvature side;(2) The gastrohepatic ligament is relatively fixed.Hence,it is not easy to expose the suprapancreatic area;and(3) It is not easy to dissect No.1,12 lymph nodes.This area may not be sufficiently cleaned or surrounding vessels may be injured during a resection.So it is critical to choose position fixing,and a clear,fast and convenient operation path.The author,based on his experience,has established a set of procedural steps called "Gao's double-way",lesser omentum approach and traditional greater omentum approach,which are described in detail in this article.The path of this first approach is described as a "W" type of dissection.The second way is the traditional greater omentum approach,whose path is described as a "M" type of dissection.This will enable laparoscopic surgeons to select a suitable path.This new approach not only simplifies the surgery but also provides more space for the subsequent operation,thereby making the surgery more simple,safe and easy.
文摘Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection(DSWI) following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males(73.7%) and 5 females(26.3%), aged 55±13(18-78) years. According to the Pairolero classification of infected median sternotomies, 3(15.8%) patients were type II, and the other 16(84.2%) were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients(78.9%), bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients(21.0%) needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients(10.5%) presented with subcutaneous infection, and 3 patients(15.8%) had hematoma. They recovered following local debridement and medication. 17 patients(89.5%) were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.
