Abstract：
BACKGROUND:Distal splenorenal shunt and coronary caval shunt are commonly used for selective decompression of esophagogastric varices, but they may not solve severe hypersplenism and their application may be hampered by the presence of splenic venous thrombosis or a left gastric vein (LGV) situated deeply behind the pancreas. On the other hand, some patients have an LGV entering the splenic vein (SV). We tried to work out a new selective shunt for this group of patients. METHODS:Sixteen patients with severe hypersplenism and esophagogastric varices received coronary renal shunt using the SV following splenectomy. After splenectomy, the proximal portion of the SV and the LGV was isolated from the pancreas. The isolated SV was divided at a point 3-5 cm left to its junction with the LGV. The proximal orifice was anastomosed to the left renal vein, and the distal orifice was ligated. A clip was applied to the SV for occlusion between the portal vein and LGV. The right gastric and gastroepiploic vessels were divided to block backflow from the portal vein and to reduce the arterial inflow of the varices. RESULTS:No operative mortality or procedure-related complications occurred. Postoperative computed tomography and endoscopy showed that all the shunts were patent and that the varices had been obliterated or markedly alleviated. In the 6-36 months' follow-up period, no recurrent variceal hemorrhage or encephalopathy occurred. CONCLUSION:Coronary renal shunt combined with splenectomy can achieve the goal of selective decompression of esophagogastric varices. It would become an alternative means of selective variceal decompression for patients whose LGV enters the SV.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Tian M,Yang Y,Jia Ddoi
10.1007/s00268-018-4796-2subject
Has Abstractpub_date
2019-02-01 00:00:00pages
590-593issue
2eissn
0364-2313issn
1432-2323pii
10.1007/s00268-018-4796-2journal_volume
43pub_type
杂志文章abstract：BACKGROUND:The present study was designed to evaluate the impact of the tyrosine kinase ligands VEGF-A/C/D, PDGF-A/B on tumor dissemination and survival in gastric cancer. This is the first study analyzing all these parameters in a homogeneous patient population undergoing surgery. METHODS:The expression pattern of VE...
journal_title：World journal of surgery
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journal_title：World journal of surgery
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