Shigemoto Jin, Kaneko Yasuyuki, Kawazu Mitsunobu, Naganobu Kiyokazu, Torisu Shidow
Oji Pet Clinic, Tokyo, Japan.
Laboratory of Companion Animal Surgery, Department of Companion Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan.
Front Vet Sci. 2024 Feb 28;11:1291006. doi: 10.3389/fvets.2024.1291006. eCollection 2024.
Laparoscopic surgery is used for canine congenital extrahepatic portosystemic shunts (CEHPSS). However, outcomes of laparoscopic surgery involving simultaneous portal vein angiography and portal pressure measurement to attenuate or completely occlude the shunt vessel in canines remain unclear. This study aimed to evaluate outcomes and complications of laparoscopic portosystemic shunt occlusion (LAPSSO) for CEHPSS.
Between June 2014 and March 2021, data on dogs undergoing cellophane banding (CB) and complete occlusion of laparoscopically treated congenital extrahepatic port shunts were collected from hospital records. Cases in which complete occlusion was laparoscopically performed, or a CB was used for gradual occlusion were included. A total of 36 dogs (14 males; median age 32.5 months [range, 5-99] with median body weight, 4.2 kg [range, 1.5-7.9]) that underwent LAPSSO for CEHPSS were included. All the dogs underwent computed tomographic angiography (CTA), and data on blood and radiological examinations were collected. Shunt vessel morphology was categorized using CTA findings. Portal pressure measurements and portal angiography were performed by accessing mesenteric and splenic veins in 30 and 6 cases, respectively.
The most common shunt types were spleno-phrenic shunts 16/36 (44.4%), followed by spleno-azygos 9/36 (25.0%), spleno-caval 4/36 (11.1%), right gastric-caval 6/36 (16.6%), and right gastric-caval with caudal loop shunts 1/36 (2.7%). The median portal pressure after complete occlusion was 11.5 mmHg (range, 4-16); portal pressures in the two dogs undergoing CB attenuation were 22 and 24 mmHg. The median operating time in the dogs with right ( = 25) and left ( = 11) recumbent positioning was 55 min (range, 28-120) and 54 min (range, 28-88), respectively. One dog had pneumothorax due to injury to the diaphragm. Another dog developed postoperative hypernatremia and succumbed 5 h post-procedure. Nevertheless, no other dogs exhibited signs of portal hypertension within 72 h. Blood tests and abdominal ultrasounds performed 1-2 months postoperatively revealed no residual shunts.
LAPSSO, coupled with portal pressure measurement and portal angiography, was shown as safe and effective approach that facilitated successful occlusion of CEHPSS. Further large-scale prospective studies and analyses of perioperative complications are needed.
腹腔镜手术用于犬先天性肝外门体分流（CEHPSS）。然而，在犬类中，涉及同时进行门静脉血管造影和门静脉压力测量以减弱或完全闭塞分流血管的腹腔镜手术结果仍不明确。本研究旨在评估腹腔镜门体分流闭塞术（LAPSSO）治疗CEHPSS的疗效和并发症。
收集2014年6月至2021年3月间接受玻璃纸包扎（CB）和腹腔镜治疗先天性肝外门体分流完全闭塞的犬的医院记录数据。纳入腹腔镜下完全闭塞或使用CB进行逐步闭塞的病例。共有36只犬（14只雄性；中位年龄32.5个月[范围5 - 99个月]，中位体重4.2 kg[范围1.5 - 7.9 kg]）接受了LAPSSO治疗CEHPSS。所有犬均接受了计算机断层血管造影（CTA），并收集了血液和放射学检查数据。根据CTA结果对分流血管形态进行分类。分别在30例和6例中通过进入肠系膜静脉和脾静脉进行门静脉压力测量和门静脉血管造影。
最常见的分流类型是脾肾分流16/36（44.4%），其次是脾奇静脉分流9/36（25.0%）、脾腔静脉分流4/36（11.1%）、右胃腔静脉分流6/36（16.6%）和右胃腔静脉伴尾袢分流1/36（2.7%）。完全闭塞后门静脉中位压力为11.5 mmHg（范围4 - 16）；接受CB减压的两只犬的门静脉压力分别为22和24 mmHg。右侧（= 25）和左侧（= 11）卧位的犬的中位手术时间分别为55分钟（范围28 - 120分钟）和54分钟（范围28 - 88分钟）。一只犬因膈肌损伤发生气胸。另一只犬术后出现高钠血症，术后5小时死亡。然而，没有其他犬在72小时内出现门静脉高压迹象。术后1 - 2个月进行的血液检查和腹部超声检查未发现残余分流。
LAPSSO结合门静脉压力测量和门静脉血管造影，是一种安全有效的方法，有助于成功闭塞CEHPSS。需要进一步进行大规模前瞻性研究和围手术期并发症分析。
