Wéber G, Geza J, Kalmár Nagy K, Cseke L, Kasza G
Pécsi Orvostudományi Egyetem I. Sebészeti Klinika.
Orv Hetil. 1994 Sep 11;135(37):2035-8.
The large vertical midline or transverse transperitoneal approaches used to the conventional aortoiliac reconstruction are accompanied with a relatively high postoperative morbidity and mortality rate (2% to 5%) even in patients who are good risks undergoing aortic surgery. The purpose of this study was develop a new technique for aorto-bifemoral bypass operation to minimize the operative stress on these patients. The recommended left paramedian retroperitoneal approach using 5-6 cm skin-incision and a special retractor with three dimensional vision and using modified surgical instruments directly with eye control, offers the possibility to decrease the operative stress significantly and the sufficient control of the serious bleeding might occur. If it is necessary this exposure can be immediately converted to a conventional approach by simply enlargement of the incision. In our first case the functional results were very good and consequently hospitalization time and the convalescence period were short. This minimal access approach appears to diminish the catabolic response and is hopefully associated with accelerated recovery and virtual abolition of large wound-related complications. It could become the procedure of choice for selected patients with obstructive or aneurysmal aorto-iliac disease.
用于传统主-髂动脉重建的大垂直中线或经腹横切口入路，即便对于主动脉手术风险较低的患者，术后发病率和死亡率也相对较高（2%至5%）。本研究的目的是开发一种新的主-双股动脉旁路手术技术，以尽量减少对这些患者的手术应激。推荐采用左旁正中腹膜后入路，使用5-6厘米的皮肤切口以及一种具有三维视野的特殊牵开器，并直接通过肉眼控制使用改良手术器械，这有可能显著降低手术应激，并能充分控制可能出现的严重出血。如有必要，只需扩大切口，这种暴露方式可立即转换为传统入路。在我们的第一例病例中，功能结果非常好，因此住院时间和康复期都很短。这种微创入路似乎能减轻分解代谢反应，有望加快康复速度，并几乎消除与大伤口相关的并发症。它可能会成为 selected 患有阻塞性或动脉瘤性主-髂动脉疾病患者的首选手术方式。 （注：原文中“selected”在句中语义不太明确，可能是特定类型的意思，但结合语境不好准确判断其准确含义，所以按原样保留翻译）
