Novel technique of laparoscopic azygoportal disconnection for treatment of esophageal varicosis - Preliminary experience with five patients
Novel technique of laparoscopic azygoportal disconnection for treatment of esophageal varicosis - Preliminary experience with five patients
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DOI：
10.1007/s00464-003-9096-7
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发表时间：
2004-04-01
影响因子：
3.1
通讯作者：
Wayand, WU
中科院分区：
文献类型：
--
作者：
Danis, J;Hubmann, R;Wayand, WU
背景：肝硬化经常导致腹水的发展和食管静脉曲张的形成。后者增加了死亡风险。最近，腹腔镜技术的重大进展使近端胃的血管离断术以微创的方式。方法：采用新技术（Danis手术）对5例患有食管静脉曲张出血（第2 ~ 11例）、肝硬化Child-Pugh分级B和C的男性患者进行腹腔镜下奇静脉门静脉断流术。该手术是在所有其他方法都未能防止再出血或被患者拒绝后进行的。5个端口位于上腹壁。通过LigaSure-Atlas器械分离小网膜中的静脉。显示胃冠状静脉，并分离所有朝向食管的近端分支以及胃短血管。打开膈裂孔，并解剖远端食管。结果：所有患者均存活。其中2例分别在术后9个月和16个月死于肝功能不全。结论：腹腔镜下贲门周围静脉断流术是一种微创的预防食管静脉曲张再出血的方法。需要进一步的研究来证实这些初步结果。
Background: Liver cirrhosis leads frequently to the development of ascites and a formation of varicose veins in the esophagus. The latter presents increased mortality risk. Recently, significant progress in laparoscopic technology enabled devascularization of the proximal stomach in a less invasive way. The results experienced by five patients are presented.Methods: Laparoscopic azygoportal disconnection was performed by means of novel technique (Danis procedure) in five men with esophagus varices bleeding (2nd to 11th events) and liver cirrhosis stage Child-Pugh B and C. This procedure was performed after all other methods had either failed to prevent recurrent bleeding or were refused by the patient. Five ports were positioned on the upper abdominal wall. The veins in the lesser omentum were divided by means of the LigaSure-Atlas device. The stomach coronary vein was visualized, and all the proximal branches toward the esophagus as well as the short gastric vessels were divided. The diaphragm hiatus was opened, and the distal esophagus was dissected. The paraesophageal venous collaterals also were divided, and the remaining varicose veins of the esophagus were interrupted by transmural stitching.Results: All the patients survived the minimally invasive procedure. Two of them died 9 and 16 months after surgery, respectively, because of liver insufficiency. No bleeding event from varicose veins in the esophagus occurred postoperatively.Conclusion: Laparoscopic azygoportal disconnection is a less invasive method for prevention of rebleeding from varicose veins in the esophagus. Further studies are necessary to confirm these preliminary results.