Vagina vasorum dissection during D2 lymphadenectomy for gastric carcinoma

AIM: To explore the relationship between metastasis and vagina vasorum in the progress of gastric carcinoma and to find some facts and references for gastric surgeons. METHODS: One hundred and seven specimens of left or right gastric arteries (55 left and 52 right) were gathered from 59 patients undergoing radical gastrectomy for gastric carcinoma. All the frozen specimens were cut into 3 μm-thick sections and stained with hematoxylin-eosin (HE) and immunohistochemical method separately. Cytokeratin (CK) and mesothelial cells (MC) were stained with immunohistochemical method. Cancer cells inside vagina vasorum were detected and the structure of artery wall was observed under microscope. RESULTS: Metastatic cancer cells or tubercles were found inside vagina vasorum in some stage Ⅲ or Ⅳ specimens, but not in stageⅠor Ⅱ specimens. Tumor cells in vagina vasorum were CK positive in 26 specimens of 14 tumors. Among them, stage Ⅲ was found in 4 specimens of 2 tumors, and stage Ⅳ in 22 specimens of 12 tumors. None of these specimens was positive for MC. The positive rate of CK increased with TNM staging. Compared with the lower part, tumors in the upper and middle parts of stomach were more likely to metastasize into vagina vasorum. CONCLUSION: Vagina vasorum dissection should be performed during D2 lymphadenectomy for TNM stage Ⅲ or Ⅳ gastric carcinoma.

胰腺系膜外科解剖及组织学观察研究

目的探讨胰腺系膜及其手术相关的解剖学和组织学基础。方法于2016年1-12月在上海交通大学基础医学院完成研究。通过对5具尸体标本胰后间隙、重要血管、后腹膜结构进行解剖观察,并对血管、后腹膜等重要结构进行组织学研究。结果胰后间隙是进行胰腺系膜切除的重要解剖层面。腹腔干、肠系膜上动脉可作为胰腺系膜切除重要的解剖标志。No.16淋巴结在外科解剖上是胰腺系膜外的结构。动脉的外膜与动脉鞘之间存在天然的外科解剖间隙,胰周动脉的动脉鞘上和鞘外有大量的神经、淋巴管分布。结论胰腺系膜切除具备相应的外科解剖学基础;动脉鞘内清扫的策略对于提高清扫效果有一定的解剖学基础。

进展期胃癌对胃周围血管鞘的影响

目的探讨胃癌发展转移过程中对胃周围动脉血管鞘的影响，为胃癌的外科治疗提供依据。方法收集2004年4月至2005年2月经外科治疗的各期胃癌患者59例共计包括血管鞘的胃左和（或）胃右动脉标本107份（胃左动脉55份，胃右动脉52份），采用冰冻切片，并应用苏木精。伊红染色、酶组织化学及免疫组织化学的方法对标本进行染色。结果Ⅰ、Ⅱ期胃癌没有发现有癌细胞转移至血管鞘内，进展期胃癌血管鞘内和（或）鞘上发现转移的癌细胞或癌细胞簇，包括2例Ⅲ期胃癌患者的4份标本和12例Ⅳ期胃癌患者的22份标本。107份血管鞘上的毛细淋巴管被5′核甘酸酶染成棕褐色，被碱性磷酸酶染成蓝色的血管鞘上毛细血管有101份，两种结构随着肿瘤的进展数目增多，密度增大（均P=0．000）。结论对于Ⅱ期以上的进展期胃癌根治术需要采用血管鞘内分离以彻底清扫动脉周围组淋巴结。