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首页> 外文期刊>Surgical Endoscopy >Laparoscopic esophagogastric devascularization in bleeding varices.
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Laparoscopic esophagogastric devascularization in bleeding varices.

机译：腹腔镜食管胃底血运重建术中静脉曲张破裂出血。

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Background: Bleeding from esophageal varices is the major cause of death in patients with portal hypertension. The ideal surgical procedure should effectively control bleeding and maintain liver function with low rates of encephalopathy. Based on this objective, laparoscopic devascularization of the lower esophagus and upper stomach was studied. Methods: Eighteen patients were studied prospectively who underwent a laparoscopic esophagogastric devascularization procedure for variceal hemorrhage. The diaphragmatic hiatus and esophagus are dissected. The lower 7 or 8 cm of esophagus is devascularized. Devascularization of the gastric fundus is then accomplished by meticulous dissection and ligation of the short gastric vessels. The hepatogastric ligament is opened, permitting identification and isolation/ligation of the left gastric vessels. The dissection and ligation of the vessels at lesser curvature proceeded up to the diaphragmatic hiatus with devascularization of the external varices from the retroperitoneum or mediastinum at the esophagogastric junction. Results: Mean operating room time was 111 min (range, 80-140 min) (6 emergent/12 elective). Mean blood loss 388 ml (range, 150-650 ml). Intensive care unit stay averaged 48 h, with a mean hospitalization of 11 days. Liver function and coagulation parameters remained stable postoperatively. Duplex sonography on the portal and splenic veins revealed patency in all patients. The flow velocity in the portal vein decreased from 15.5 +/- 4.1 to 13.4 +/- 3.5 cm/s postoperatively ( p = 0.021). Splenic vein velocity was unchanged. Bleeding recurred in 6 patients, and grade 1 encephalopathy developed in 1 patient. Follow-up endoscopy (8-24 months) demonstrated substantial reduction in variceal grade. Conclusion: Laparoscopic devascularization of the lower esophagus and the upper stomach is technically feasible and promising. Rapid recovery and control of variceal hemorrhage are accomplished in most patients without exposing them to the risk of open surgery.
机译：背景：食管静脉曲张破裂出血是门脉高压患者的主要死亡原因。理想的外科手术程序应有效控制出血，并以低脑病率维持肝功能。基于这一目标，研究了腹腔镜下食管和上胃的血运重建。方法：前瞻性研究了18例因腹腔镜食管胃反流术治疗静脉曲张破裂出血的患者。解剖肌裂孔和食道。食管下部7或8厘米进行了血运重建。然后通过仔细解剖和结扎胃短血管来完成胃底的血运重建。肝胃韧带打开，可以识别和隔离/结扎左胃血管。在较小的曲率处进行血管的解剖和结扎，直至the肌裂孔，伴有食管胃交界处的腹膜后或纵隔的外部静脉曲张脱血管。结果：平均手术室时间为111分钟（范围为80-140分钟）（6次紧急/ 12次选修）。平均失血388毫升（范围150-650毫升）。重症监护室平均住院时间为48小时，平均住院时间为11天。术后肝功能和凝血参数保持稳定。门静脉和脾静脉的双超声检查显示所有患者通畅。术后门静脉的流速从15.5 +/- 4.1降低到13.4 +/- 3.5 cm / s（p = 0.021）。脾静脉速度未改变。 6例患者复发出血，1例患者发展为1级脑病。随访内镜检查（8-24个月）显示静脉曲张分级明显降低。结论：腹腔镜下食管和上胃的血运重建术在技术上是可行的并且有希望。在大多数患者中，静脉曲张出血的快速恢复和控制得以实现，而没有使他们暴露于开放手术的风险中。

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