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Transjugular intrahepatic portosystemic shunt plus embolization for bleeding esophagojejunal varices after total gastrectomy

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Journal of Interventional Medicine 2019年第4期2卷 181-183页

作者： Shaojie Wu Yicheng Wu Yanfu Shen Senlin Cai Yanfeng Zhou Haotian Zheng Zhuting Fang Department of Interventional Radiology Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityNo.134Dongjie RoadFuzhou350001China Department of Geriatrics Fujian Provincial HospitalFujian Provincial Center for GeriatricsShengli Clinical Medical College of Fujian Medical UniversityNo.134Dongjie RoadFuzhou350001China Department of Radiology Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityNo.134Dongjie RoadFuzhou350001China

A 64-year-old man was admitted to our hospital with hematemesis and melena.Six years ago,he had undergone total gastrectomy with Roux-en-Y esophagojejunostomy for gastric cancer.Endoscopic examination revealed varicose veins at the anastomotic sites with cherry-red spots and hemorrhage.Abdominal computed tomography showed that the varices were supplied by a dilated jejunal vein.Transjugular intrahepatic portosystemic shunt(TIPS)and variceal embolization were performed.There were no major complications or episodes of bleeding during the three-month follow-up.We conclude that TIPS in combination with varices obliteration is an effective alternative method for treatment of ruptured esophagojejunal varices after total gastrectomy.

关键词： esophagojejunal varices Transjugular intrahepatic portosystemic shunt Varices obliteration Total gastrectomy

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Full robot-assisted gastrectomy with intracorporeal robot-sewn anastomosis produces satisfying outcomes

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World Journal of Gastroenterology 2013年第38期19卷 6427-6437页

作者： Xin-Xin Liu Zhi-Wei Jiang Ping Chen Yan Zhao Hua-Feng Pan Jie-Shou Li Department of Gastrointestinal Surgery Subei People’s Hospital of Jiangsu Province Post-doctoral Mobile Stations of Nanjing University Clinical Medical College of Yangzhou University Department of General Surgery Jinling HospitalSchool of MedicineNanjing University

AIM:To evaluate the feasibility and safety of full robotassisted gastrectomy with intracorporeal robot handsewn anastomosis in the treatment of gastric cancer.METHODS:From September 2011 to March 2013,110consecutive patients with gastric cancer at the authors’institution were enrolled for robotic gastrectomies.According to tumor location,total gastrectomy,distal or proximal subtotal gastrectomy with D2 lymphadenectomy was fully performed by the da Vinci Robotic Surgical System.All construction,including Roux-en-Y jejunal limb,esophagojejunal,gastroduodenal and gastrojejunal anastomoses were fully carried out by the intracorporeal robot-sewn method.At the end of surgery,the specimen was removed through a 3-4 cm incision at the umbilicus trocar point.The details of the surgical technique are well illustrated.The benefits in terms of surgical and oncologic outcomes are well documented,as well as the failure rate and postoperative complications.RESULTS:From a total of 110 enrolled patients,radical gastrectomy could not be performed in 2 patients due to late stage disease;1 patient was converted to laparotomy because of uncontrollable hemorrhage,and1 obese patient was converted due to difficult exposure;2 patients underwent extra-corporeal anastomosis by minilaparotomy to ensure adequate tumor margin.Robot-sewn anastomoses were successfully performed for 12 proximal,38 distal and 54 total gastrectomies.The average surgical time was 272.52±53.91 min and the average amount of bleeding was 80.78±32.37 mL.The average number of harvested lymph nodes was 23.1±5.3.All specimens showed adequate surgical margin.With regard to tumor staging,26,32 and 46 patients were staged asⅠ,ⅡandⅢ,respectively.The average hospitalization time after surgery was 6.2 d.One patient experienced a duodenal stump anastomotic leak,which was mild and treated conservatively.One patient was readmitted for intra-abdominal infection and was treated conservatively.Jejunal afferent loop obstruction occurred in 1 patient,who underwent re-operation and recov

关键词： Robotic surgery Gastric cancer Total gastrectomy esophagojejunal anastomosis

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