Arya Nityanand, Lau Luk Louis, Lee Bernard, Hannon Raymond J, Young Ian S
Vascular Unit, Belfast City Hospital, Belfast, United Kingdom.
Vasc Endovascular Surg. 2009 Jun-Jul;43(3):262-70. doi: 10.1177/1538574408330400. Epub 2009 Feb 3.
To assess the effect of intestinal manipulation and mesenteric traction on gastro-intestinal function and postoperative recovery in patients undergoing abdominal aortic aneurysm (AAA) repair.
Thirty-five patients undergoing AAA repair were randomised into 3 groups. Group I (n = 11) had repair via retroperitoneal approach while Group II (n = 12) and Group III (n = 12) were repaired via transperitoneal approach with bowel packed within the peritoneal cavity or exteriorised in a bowel bag respectively. Gastric emptying was measured pre-operatively (day 0), day 1 and day 3 using paracetamol absorption test (PAT) and area under curve (P(AUC)) was calculated. Intestinal permeability was measured using the Lactulose-Mannitol test.
Aneurysm size, operation time and PAT (on day 0 and day 3) were similar in the three groups. On day 1, the P(AUC) was significantly higher in Group I, when compared with Group II and Group III (P = .02). Resumption of diet was also significantly earlier in Group I as compared to Group II and Group III. The intestinal permeability was significantly increased in Group II and Group III at day 1 when compared with day 0, with no significant increase in Group I. Retroperitoneal repair was also associated with significantly shorter intensive care unit (P = .04) and hospital stay (P = .047), when compared with the combined transperitoneal repair group (Group II and III).
Retroperitoneal AAA repair minimises intestinal dysfunction and may lead to quicker patient recovery when compared to transperitoneal repair.
评估肠道操作和肠系膜牵引对腹主动脉瘤（AAA）修复患者胃肠功能及术后恢复的影响。
35例行AAA修复术的患者被随机分为3组。I组（n = 11）采用腹膜后入路进行修复，而II组（n = 12）和III组（n = 12）分别采用经腹入路，将肠管包埋于腹腔内或外置在肠袋中。术前（第0天）、术后第1天和第3天采用对乙酰氨基酚吸收试验（PAT）测量胃排空，并计算曲线下面积（P（AUC））。采用乳果糖-甘露醇试验测量肠道通透性。
三组患者的动脉瘤大小、手术时间和PAT（第0天和第3天）相似。与II组和III组相比，I组在第1天的P（AUC）显著更高（P = 0.02）。与II组和III组相比，I组恢复饮食的时间也显著更早。与第0天相比，II组和III组在第1天的肠道通透性显著增加，而I组无显著增加。与经腹联合修复组（II组和III组）相比，腹膜后修复还与显著缩短重症监护病房住院时间（P = 0.04）和住院时间（P = 0.047）相关。
与经腹修复相比，腹膜后AAA修复可将肠道功能障碍降至最低，并可能使患者恢复更快。
