Hashizume M, Tanoue K, Morita M, Ohta M, Tomikawa M, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Am Coll Surg. 1998 Sep;187(3):263-70. doi: 10.1016/s1072-7515(98)00181-1.
The combination of sclerotherapy with surgical salvage for sclerotherapy-resistant esophagogastric varices has recently received much attention, however, the longterm results after such an operation have yet to be reported. This is a preliminary report of a laparoscopic adaptation of a previously described surgical procedure for the treatment of refractory esophagogastric varices.
Laparoscopic gastric devascularization and splenectomy (Hassab's operation) was successfully performed to treat recurrent sclerotherapy-resistant giant esophageal varices (n=4) and recurrent rebleeding gastric varices (n=6). The patients included 8 men and 2 women who ranged in age from 35 to 67 years (average, 54.2 years). The procedure and clinical results were evaluated from various viewpoints.
The duration of the operation ranged from 200 to 400 minutes (mean+/-standard deviation; 287.5+/-66.0 minutes) and blood loss from 10 to 1,500 mL (average, 515.5+/-507.9 mL). The weight of the spleen ranged from 500 to 850 g (average 608.0+/-126.6 g). Conversion to minimal open operation with a gasless lifting method was done in 1 patient because of uncontrolled bleeding from the splenic vein. There were no other major complications either intraoperatively or postoperatively. All patients had hypersplenism; preoperative platelet counts ranged from 1.6 to 6.8 x 10(4)/microL (average, 4.5+/-2.7 x 10(4) microL) and the postoperative count was from 5.9 to 36.0 x 10(4)/microL (average, 21.7+/-11.5 x 10(4) microL). Postoperative endoscopy revealed that varices disappeared, and no patient had recurrence of the varices after operation during the mean followup period of 12.8+/-4.1 months (average, 8 to 20 months).
The combination of laparoscopic gastric devascularization and splenectomy for sclerotherapy-resistant esophagogastric varices is considered a feasible and relatively safe surgical method for patients with hypersplenism.
硬化疗法联合手术挽救治疗对硬化疗法耐药的食管胃静脉曲张最近备受关注，然而，此类手术后的长期结果尚未见报道。本文是关于一种先前描述的用于治疗难治性食管胃静脉曲张的手术的腹腔镜改良术的初步报告。
成功实施腹腔镜胃去血管化和脾切除术（哈萨布手术）以治疗复发性对硬化疗法耐药的巨大食管静脉曲张（4例）和复发性再出血胃静脉曲张（6例）。患者包括8名男性和2名女性，年龄在35至67岁之间（平均54.2岁）。从多个角度对手术过程和临床结果进行了评估。
手术时间为200至400分钟（平均±标准差；287.5±66.0分钟），失血量为10至1500毫升（平均515.5±507.9毫升）。脾脏重量为500至850克（平均608.0±126.6克）。1例患者因脾静脉出血无法控制而转为采用无气举升法的微创开放手术。术中及术后均无其他严重并发症。所有患者均有脾功能亢进；术前血小板计数为1.6至6.8×10⁴/微升（平均4.5±2.7×10⁴微升），术后计数为5.9至36.0×10⁴/微升（平均21.7±11.5×10⁴微升）。术后内镜检查显示静脉曲张消失，在平均12.8±4.1个月（平均8至20个月）的随访期内，无患者术后静脉曲张复发。
对于脾功能亢进患者，腹腔镜胃去血管化和脾切除术联合治疗对硬化疗法耐药的食管胃静脉曲张被认为是一种可行且相对安全的手术方法。
