Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy.
Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy.
复制标题
基于CT血管解剖学定制腹腔镜胃静脉曲张断流脾切除术。
DOI：
10.1007/s00464-017-5646-2
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Maehara Y.
中科院分区：
文献类型：
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作者：
Kawanaka H;Akahoshi T;Nagao Y;Kinjo N;Yoshida D;Matsumoto Y;Harimoto N;Itoh S;Yoshizumi T;Maehara Y.
背景腹腔镜胃底静脉曲张行胃血管离断术（Lap GDS）和脾切除术（SPL）是一项技术上具有挑战性的手术，因为胃底静脉曲张侧支血管高度发达，有出血倾向。我们研究了基于CT血管解剖学定制Lap GDS和SPL的可行性。MethodsWe分析了2006年至2014年期间接受Lap GDS和SPL的61例胃静脉曲张患者。腹腔镜下GDS根据输入供血静脉定制（胃左静脉（LGV）和/或胃后静脉（PGV）/胃短静脉（SGV））和输出引流静脉（胃肾分流和/或胃膈分流，结果34例适合球囊闭塞逆行经静脉闭塞术（B-RTO）的输出引流静脉患者接受了B-RTO代替手术GDS，随后进行腹腔镜SPL。27例胃底静脉曲张不适合B-RTO的患者中，15例PGV/SGV患者接受了大弯和SPL的Lap GDS，12例LGV或LGV/PGV/SGV患者接受了大、小弯和SPL的Lap GDS。平均手术时间为294 min，平均失血量为198 g。无死亡或严重发病。所有61例患者的胃静脉曲张均被根除，在平均55.9个月的随访期间没有出血或复发。3年、5年和7年累积生存率分别为92%、82%和64%。结论根据CT血管解剖学定制的Lap GDS和SPL是治疗胃静脉曲张的安全有效的手术方法。
BackgroundLaparoscopic gastric devascularization(Lap GDS) and splenectomy (SPL) for gastric varices is technically challenging because of highly developed collateral vessels and bleeding tendency. We investigated the feasibility of customization of Lap GDS and SPL based on CT vascular anatomy.MethodsWe analyzed 61 cirrhotic patients with gastric varices who underwent Lap GDS and SPL between 2006 and 2014. Lap GDS was customized according to the afferent feeding veins (left gastric vein (LGV) and/or posterior gastric vein (PGV)/short gastric vein (SGV)) and efferent drainage veins (gastrorenal shunt and/or gastrophrenic shunt, or numerous retroperitoneal veins) based on CT imaging.ResultsThirty-four patients with efferent drainage veins suitable for balloon-occluded retrograde transvenous obliteration (B-RTO) underwent B-RTO instead of surgical GDS, with subsequent Lap SPL. Among 27 patients with gastric varices unsuitable for B-RTO, 15 patients with PGV/SGV underwent Lap GDS of the greater curvature and SPL, and 12 patients with LGV or LGV/PGV/SGV underwent Lap GDS of the greater and lesser curvature and SPL. The mean operation time was 294 min and mean blood loss was 198 g. There was no mortality or severe morbidity. Gastric varices were eradicated in all 61 patients, with no bleeding or recurrence during a mean follow-up of 55.9 months. The cumulative 3-, 5-, and 7-year survival rates were 92, 82, and 64%, respectively.ConclusionsLap GDS and SPL customized based on CT vascular anatomy is a safe and effective procedure for treating gastric varices.