Alimi Y S, Hartung O, Orsoni P, Juhan C
Service de Chirurgie Vasculaire - Hôpital Nord, Université de la Méditérranée, Marseille, France.
Eur J Vasc Endovasc Surg. 2000 Jan;19(1):21-6. doi: 10.1053/ejvs.1999.0933.
to define the respective advantages and pitfalls of the trans- or retroperitoneal approaches in laparoscopic abdominal aortic reconstruction (LAOR).
prospective study.
ten patients (8 males; average age 58) underwent an aortouni- (n=2) or bifemoral bypass (n=8) to treat aortoiliac occlusive disease (n=8) or an aortic aneurysm (n=2).
a retroperitoneal approach (the "apron" technique) was used in the first 5 cases (Group I) and a transperitoneal approach in the last 5 cases (Group II).
no early or late death occurred, and all bypasses remain patent after a mean follow-up of 5.7 months. Mean surgical and clamping times are similar in both groups (370 and 126 min in Group I; 324 and 137 min in Group II). One intraoperative conversion to open surgery and two postoperative surgical complications occurred in Group I. Four minilaparotomies of 8-10 cm were necessary in Group II. Two patients were discharged on postoperative day 6 in Group I and five in Group II.
this preliminary study shows the feasibility of LAOR through both approaches. In Group II, a better exposure of the right aortic wall and of the right iliac axis was noted and division of the inferior mesenteric artery was not always necessary.
明确腹腔镜腹主动脉重建术（LAOR）中经腹和经腹膜后两种入路各自的优势与不足。
前瞻性研究。
10例患者（8例男性；平均年龄58岁）接受了主动脉单（n = 2）或双股动脉搭桥术（n = 8），以治疗主髂动脉闭塞性疾病（n = 8）或主动脉瘤（n = 2）。
前5例患者（I组）采用经腹膜后入路（“围裙”技术），后5例患者（II组）采用经腹入路。
无早期或晚期死亡病例，平均随访5.7个月后所有搭桥血管均保持通畅。两组的平均手术时间和阻断时间相似（I组分别为370分钟和126分钟；II组分别为324分钟和137分钟）。I组有1例术中转为开放手术，2例术后出现手术并发症。II组需要进行4次8 - 10厘米的小切口开腹手术。I组有2例患者术后第6天出院，II组有5例。
这项初步研究表明两种入路进行LAOR均可行。在II组中，观察到对主动脉右侧壁和右髂动脉轴的暴露更好，且并非总是需要切断肠系膜下动脉。
