Grotemeyer D, Iskandar F, Voshege M, Blondin D, Pourhassan S, Grabitz K, Sandmann W
Klinik für Gefässchirurgie und Nierentransplantation, Universitätsklinikum der Heinrich-Heine-Universität Düsseldorf.
Zentralbl Chir. 2009 Aug;134(4):338-44. doi: 10.1055/s-0028-1098777. Epub 2009 Mar 31.
In 2001 Leschi et al. published a new method to improve perfusion of the superior mesenteric artery (SMA) in operative therapy of acute and chronic visceral ischemia. They presented a retrograde aorto-mesenteric bypass following an arcuate course behind the left renal pedicle. Due to the intricate correct anatomic description of this vascular reconstruction this loop bypass was named the "French bypass".
In our department 84 patients underwent surgery because of an acute or chronic visceral ischemia between January 2002 and December 2007. Out of these patients 27 received a "French bypass". The pre-, intra-, and postoperative data were collected from the patient hospital files retrospectively. The follow-up consisted of a review of the patient history and clinical findings in an outpatient setting, combined with a duplex sonography of the visceral arteries.
The group of 27 patients had an average age of 55.0 years: (range: 29-81 years) and consisted of 21 women (78.6 %) and 6 men (21.4 %). The cardinal symptom of all patients was abdominal pain of variable intensities. 14 patients complained about an increased pain post ingestion (abdominal angina) and 12 patients about an involuntary loss of weight. Bypass material was autologous saphenous vein in 18 patients (66.7 %) and in 9 patients (33.3 %) an 8-mm ring-enforced PTFE prosthesis. Apart from 10 patients who only received the French bypass, we performed comprehensive visceral revascularisations in 12 patients. Overall hospital mortality was 18.5 %; 4 out of the 5 deceased patients had undergone surgery due to acute visceral ischemia. The mortality of patients with acute visceral ischemia was 30.8 % and of patients with chronic visceral ischemia 7.1 %. Eight patients had a revision before -discharge from hospital (surgery n = 6, interventional n = 2). Primary and secondary patencies of the bypasses of the surviving patients were 54.6 % (12 out of 22 patients) and 81.8 % (18 out of 22 patients), respectively. Concerning the end-point "freedom from abdominal complaints" 14 out of 27 patients (51.9 %) benefited after a mean follow-up of 38.9 months (range: 3-84 months), 7 patients each in the acute and chronic visceral ischemia group.
The implantation of a "French bypass" represents a good option to reconstruct the SMA, combining the advantages of ante- and retrograde visceral bypasses. Furthermore this -bypass procedure allows to reconstruct distal segments of the -superior mesenteric artery in cases when long distance and peripheral stenosis impeded local thromendarterectomy. Perioperative morbidity and mortality are acceptable when the acute clinical situation is taken into account. The long-term benefit for the patients with regard to the prevention of intestinal ischemia and also the freedom from complaints is high.
2001年，莱施等人发表了一种新方法，用于在急性和慢性内脏缺血的手术治疗中改善肠系膜上动脉（SMA）的灌注。他们提出了一种在左肾蒂后方呈弓形走行的逆行主动脉-肠系膜旁路术。由于这种血管重建的解剖描述复杂且正确，这种袢式旁路术被命名为“法国旁路术”。
2002年1月至2007年12月期间，在我们科室，84例患者因急性或慢性内脏缺血接受了手术。其中27例患者接受了“法国旁路术”。术前、术中和术后数据均从患者医院病历中进行回顾性收集。随访包括在门诊环境中回顾患者病史和临床检查结果，并结合内脏动脉的双功超声检查。
27例患者的平均年龄为55.0岁（范围：29 - 81岁），其中女性21例（78.6%），男性6例（21.4%）。所有患者的主要症状为程度不一的腹痛。14例患者诉说进食后疼痛加剧（腹绞痛），12例患者诉说体重非自愿减轻。18例患者（66.7%）的旁路材料为自体大隐静脉，9例患者（33.3%）使用的是8毫米环加强聚四氟乙烯人工血管。除了10例仅接受法国旁路术的患者外，我们对12例患者进行了全面的内脏血管重建。总体医院死亡率为18.5%；5例死亡患者中有4例因急性内脏缺血接受了手术。急性内脏缺血患者的死亡率为30.8%，慢性内脏缺血患者的死亡率为7.1%。8例患者在出院前进行了翻修（手术6例，介入治疗2例）。存活患者旁路的一期和二期通畅率分别为54.6%（22例患者中的12例）和81.8%（22例患者中的18例）。关于“无腹部不适”这一终点指标，27例患者中有14例（51.9%）在平均随访38.9个月（范围：3 - 84个月）后受益，急性和慢性内脏缺血组各有7例。
“法国旁路术”的植入是重建肠系膜上动脉的一个良好选择，它结合了顺行和逆行内脏旁路术的优点。此外，当长距离和外周狭窄妨碍局部血栓内膜切除术时，这种旁路手术允许重建肠系膜上动脉的远端节段。考虑到急性临床情况，围手术期发病率和死亡率是可以接受的。对于预防肠道缺血以及使患者免于不适，该手术对患者的长期益处很大。
