Benko László, Danis Jan, Shamiyeh Andreas, Czompo Manfred, Gasz Balázs, Ferencz Andrea, Jancsó Gábor, Roth Erzsébet
Pécsi TudomBnyegyetem, Altalános Orvostudományi Kar, Sebészeti Oktaó6 és Kutató Intézet.
Magy Seb. 2006 Feb;59(1):45-9.
In this study we proved the feasibility of a new minimally invasive procedure for the devascularisation of the proximal stomach and the abdominal esophagus to prevent recurrent variceal bleeding in portal hypertension in a new animal model.
Experiments were performed on 12 female pigs, in two animal groups. In the first step (I. group n=6) portal hypertension was created by controlled laparoscopic clip ligation of the portal vein. The increased portal pressure was established by the needle puncture of the portal vein and the spleen. Two weeks later, the dilated veins were sealed along the lesser and greater curvature and the transhiatal esophagus with the 10 mm LigaSure instrument. Successful of the experimental model had encouraged us to perform this method on other animals (II. group, n=6), using the 5 mm instrument.
There was no intraoperative bleeding after using both LigaSure instruments. Autopsy (2 weeks later) showed correct placed clips with partial occlusion of the portal vein without portal vein thrombosis. There was no evidence of postoperative bleeding. Histological investigation of the gastric surface confirmed complete sealing of the extended varices.
The laparoscopic LigaSure instrument was found to be safe and suitable equipment for the ligation of the dilated veins along the gastric surface and the abdominal esophagus, and this method could be an alternate choice for the patients with recurrent variceal bleeding.
在本研究中，我们在一种新的动物模型中证明了一种用于近端胃和腹部食管去血管化的新的微创程序对于预防门静脉高压症复发性静脉曲张出血的可行性。
对12只雌性猪进行实验，分为两个动物组。第一步（第一组，n = 6）通过腹腔镜控制下夹闭门静脉来制造门静脉高压。通过门静脉和脾脏的针刺来确定门静脉压力升高。两周后，使用10毫米LigaSure器械沿小弯和大弯以及经裂孔食管封闭扩张的静脉。实验模型的成功促使我们使用5毫米器械在其他动物（第二组，n = 6）上实施该方法。
使用两种LigaSure器械后均无术中出血。尸检（两周后）显示夹子放置正确，门静脉部分闭塞但无门静脉血栓形成。没有术后出血的证据。胃表面的组织学检查证实扩张的静脉曲张已完全封闭。
发现腹腔镜LigaSure器械是用于沿胃表面和腹部食管结扎扩张静脉的安全且合适的设备，并且该方法可能是复发性静脉曲张出血患者的一种替代选择。
