Cardiff Regional Vascular Unit, University Hospital of Wales, Cardiff, Wales, United Kingdom.
J Vasc Surg. 2012 Sep;56(3):834-8. doi: 10.1016/j.jvs.2012.04.021. Epub 2012 Jul 12.
The aim of this review was to assess the place of retroperitoneal (RP) aortic surgery for abdominal aortic aneurysms (AAAs) in the endovascular era and evaluate the evidence supporting it in preference to the more traditional transperitoneal approach. As endovascular graft technology improves, open aortic surgery is declining. AAAs unsuitable for endovascular aneurysm repair are, by definition, anatomically challenging. The RP approach is especially suited to anatomic challenges such as those posed by contemporary open AAA because it facilitates access to the suprarenal aorta. There is evidence that the RP approach reduces postoperative morbidity and length of stay compared with transperitoneal approaches. The evidence available indicates that the RP approach should be the first considered for any AAA unsuitable for endovascular aneurysm repair; however, the technique is more difficult to learn and less commonly practiced than the transperitoneal approach. Combined with a decrease in training hours in the United Kingdom, there is a real threat that the RP technique will only be performed by an ever-decreasing number of enthusiasts.
本综述旨在评估腹主动脉瘤（AAA）的腹膜后（RP）主动脉手术在血管内治疗时代的地位，并评估支持其优于更传统的经腹腔入路的证据。随着血管内移植物技术的不断提高，开放主动脉手术的数量正在减少。根据定义，不适合血管内修复的 AAA 在解剖学上具有挑战性。RP 入路特别适合于当代开放 AAA 所带来的解剖学挑战，因为它便于接触肾上主动脉。有证据表明，与经腹腔入路相比，RP 入路可降低术后发病率和住院时间。现有的证据表明，对于任何不适合血管内动脉瘤修复的 AAA，RP 入路应首先考虑；然而，该技术比经腹腔入路更难学习，且实施频率更低。再加上英国培训时间的减少，RP 技术确实有可能仅由越来越少的热衷于该技术的医生实施。
