Hand-assisted laparoscopic splenectomy and devascularization of the upper stomach in the management of gastric varices.
Hand-assisted laparoscopic splenectomy and devascularization of the upper stomach in the management of gastric varices.
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DOI：
10.1007/s00268-005-0243-2
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发表时间：
2006-08
影响因子：
2.6
通讯作者：
Maeda K
中科院分区：
文献类型：
--
作者：
Yamamoto J;Nagai M;Smith B;Tamaki S;Kubota T;Sasaki K;Ohmori T;Maeda K
食道胃底静脉曲张出血是门脉高压症患者死亡的主要原因。虽然食道静脉曲张可以通过内窥镜手术治疗，但胃底静脉曲张的治疗仍然存在争议。本研究的目的是描述手助腹腔镜哈萨布氏手术的手术技巧和初步结果。2002年2月至2005年5月，我们用这种手术方式施行了7例胃底静脉曲张。其中男4例，女3例，年龄23~74岁，基础肝病：肝硬变5例，多囊肝1例，肝外门静脉阻塞1例。行脾切除后，离食道-贲门交界处5 cm处切断上胃和食道的血管。手术时间132~290分钟。术中出血量50~475ml，摘除脾重量110~800g，术后胃底静脉曲张全部消失，无静脉曲张出血。所有患者术前均有脾功能亢进伴血小板减少(平均11.1±7.4×104/ml)，术后改善(平均30.8±19.0×104/ml)。这一数据具有统计学意义(P=0.033)。1例死于术后幽门狭窄相关的吸入性肺炎。尽管对于胃底静脉曲张的最佳治疗方法还没有达成一致意见，但手助腹腔镜术是一种安全、中等侵入性的手术方法，其结果似乎与其他开腹手术相同。
Bleeding from esophagogastric varices is the major cause of death in patients with portal hypertension. Although esophageal varices can be treated with endoscopic procedures, the treatment for gastric varices is still controversial. The aim of this study was to describe a surgical technique and our preliminary results of hand-assisted laparoscopic Hassab’s procedure. Between February 2002 and May 2005, we performed 7 cases of gastric varices with this type of operation. The patients included 4 men and 3 women who ranged in age from 23 to 74 years (underlying liver disease: 5 case of liver cirrhosis, 1 case of polycystic disease, 1 case of extrahepatic portal vein obstruction). After splenctomy was performed, we devascularized the vessels of the upper stomach and the esophagus 5 cm away from the esophago-cardia junction. The operative time ranged from 132 to 290 minutes. Intraoperative blood loss was estimated to be from 50 ml to 475 ml. The weight of removed spleen ranged from 110 g to 800 g. During the follow-up period, all gastric varices disappeared and no bleeding from varicose veins was observed. All patients had hypersplenism with thrombocytopenia before surgery (mean: 11.1 ± 7.4 × 104/ml), which was improved postoperatively (mean: 30.8 ±19.0 × 104/ml). This data were statistically significant (P = 0.033). One patient died of aspiration pneumonia related to postoperative pyloric stricture. Although there is no agreement concerning the best treatment of gastric varices, the hand-assisted laparoscopic Hassab’s operation is a safe, moderately invasive method, and its outcome appears to be equal to that of other open procedures.
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影响因子：
29.4
作者：
Casado, M;Bosch, J;Rodés, J
通讯作者：
Rodés, J
影响因子：
7.7
作者：
Sarin, SK
通讯作者：
Sarin, SK
DOI：
10.1007/s00464-003-9096-7
发表时间：
2004-04-01
影响因子：
3.1
作者：
Danis, J;Hubmann, R;Wayand, WU
通讯作者：
Wayand, WU
影响因子：
9
作者：
Rikkers, LF
通讯作者：
Rikkers, LF
影响因子：
2.6
作者：
DAGENAIS, M;LANGER, B;GREIG, PD
通讯作者：
GREIG, PD