Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Clinical Research Institute and Department of Surgery, National Beppu Medical Center, 1473 Uchikamado, Beppu, 874-0011, Japan.
Surg Endosc. 2018 Jan;32(1):114-126. doi: 10.1007/s00464-017-5646-2. Epub 2017 Jun 21.
Laparoscopic 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.
We 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.
Thirty-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.
Lap GDS and SPL customized based on CT vascular anatomy is a safe and effective procedure for treating gastric varices.
腹腔镜胃去血管化（Lap GDS）和脾切除术（SPL）治疗胃静脉曲张具有技术挑战性，因为侧支血管高度发达且存在出血倾向。我们研究了基于 CT 血管解剖结构定制 Lap GDS 和 SPL 的可行性。
我们分析了 2006 年至 2014 年间接受 Lap GDS 和 SPL 的 61 例肝硬化胃静脉曲张患者。根据 CT 成像，根据流入性供养静脉（胃左静脉（LGV）和/或胃后静脉（PGV）/胃短静脉（SGV））和流出性引流静脉（胃肾分流和/或胃膈分流，或许多腹膜后静脉）定制 Lap GDS。
34 例流出性引流静脉适合球囊闭塞逆行经静脉闭塞（B-RTO）的患者接受 B-RTO 代替手术 GDS，随后进行 Lap SPL。在 27 例不适合 B-RTO 的胃静脉曲张患者中，15 例 PGV/SGV 患者接受了胃大弯 Lap GDS 和 SPL，12 例 LGV 或 LGV/PGV/SGV 患者接受了胃大弯和小弯 Lap GDS 和 SPL。手术时间平均为 294 分钟，失血量平均为 198 克。无死亡或严重并发症。61 例患者胃静脉曲张均被根除，平均随访 55.9 个月期间无出血或复发。3、5、7 年累积生存率分别为 92%、82%和 64%。
基于 CT 血管解剖结构定制的 Lap GDS 和 SPL 是治疗胃静脉曲张的一种安全有效的方法。
