Polyzos Dimitrios, Papadopoulos Nikolaos, Chapman Lynne, Papalampros Panos, Varela Vasiliki, Gambadauro Pietro, Magos Adam
Minimally Invasive Therapy Unit & Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG, England.
Acta Obstet Gynecol Scand. 2007;86(2):235-9. doi: 10.1080/00016340601090147.
Injury to major retroperitoneal vessels is the most catastrophic complication of laparoscopy. Knowledge of the site of the aortic bifurcation prior to inserting the umbilical port would be expected to reduce the risk of this type of injury. The aim of the study is to determine the feasibility of identifying the aortic bifurcation by palpation prior to the operation.
We studied 100 patients undergoing laparoscopic surgery or laparotomy. After prepping and draping, the operating surgeon felt for the aortic bifurcation to determine its position in relation to the umbilicus. We then related our findings to the height, weight, and body mass index of the patient.
The aorta could not be palpated in 15% of cases, including almost 2/3 of women who were obese (body mass index >30). In the remaining 85% cases, where the aorta was palpable, the bifurcation was above the level of the umbilicus in 30 (35%) cases, at the umbilicus in 45 (53%) cases, and below in 10 (12%) cases. We did not find any significant effect of body mass index, height, or weight on the level of the aortic bifurcation by palpation. No vascular injury occurred in the laparoscopic cases during the study.
The aortic bifurcation is palpable in the majority of women undergoing surgery, including 93% of those with a low or normal body mass index who are at higher risk of vascular injury. We recommend the routine palpation for the aortic bifurcation as a simple means to reduce the risk of injury to a major retroperitoneal vessel.
腹膜后主要血管损伤是腹腔镜手术最严重的并发症。在插入脐部端口前了解主动脉分叉的位置有望降低此类损伤的风险。本研究的目的是确定术前通过触诊识别主动脉分叉的可行性。
我们研究了100例接受腹腔镜手术或剖腹手术的患者。在进行皮肤准备和铺巾后，手术医生触摸主动脉分叉以确定其相对于脐部的位置。然后我们将研究结果与患者的身高、体重和体重指数相关联。
15%的病例无法触及主动脉，其中包括近三分之二肥胖（体重指数>30）的女性。在其余85%可触及主动脉的病例中，分叉位于脐部水平上方的有30例（35%），位于脐部水平的有45例（53%），位于脐部水平下方的有10例（12%）。我们未发现体重指数、身高或体重对通过触诊确定的主动脉分叉水平有任何显著影响。在研究期间，腹腔镜手术病例中未发生血管损伤。
大多数接受手术的女性可触及主动脉分叉，包括93%体重指数低或正常且血管损伤风险较高的女性。我们建议常规触诊主动脉分叉，作为降低腹膜后主要血管损伤风险的一种简单方法。
