Kwaan J H, Humphrey R, Connolly J E
Am Surg. 1982 Jul;48(7):351-4.
Seventy-five consecutive aortic reconstructive procedures were performed via a left paramedian extraperitoneal approach. These operations included abdominal aortic aneurysmectomies in 28 patients and aortobifemoral grafts in 43. These were combined with aorto-left-renal bypass in four patients and removal of infected aortic prostheses in four other patients. This modified technic obviated the need for excessive retraction by combining the benefits of a paramedian approach with a full-length abdominal incision. Distinct advantage include decrease postoperative abdominal discomfort, minimal paralytic ileus, as well as a shortened convalescence. This extraperitoneal approach is not only suitable for routine aortic reconstructive procedures, but has proven to be especially valuable in cases where increased morbidity is likely with infringement of the peritoneal cavity, such as patients with extensive bowel adhesion, previous colostomy, or infection aortic grafts requiring removal.
通过左旁正中腹膜外入路连续进行了75例主动脉重建手术。这些手术包括28例腹主动脉瘤切除术和43例主动脉双股动脉移植术。其中4例患者行主动脉-左肾旁路术，另外4例患者切除感染的主动脉假体。这种改良技术通过结合旁正中入路和全长腹部切口的优点，避免了过度牵拉的需要。明显的优势包括术后腹部不适减轻、麻痹性肠梗阻最少以及康复期缩短。这种腹膜外入路不仅适用于常规主动脉重建手术，而且已证明在侵犯腹腔可能增加发病率的情况下特别有价值，例如有广泛肠粘连、既往结肠造口术或需要切除感染主动脉移植物的患者。
