Gayral M, Reveilleau P, Duchemin J F, Nassredine H, Chevalier J M
Service de chirurgie vasculaire, Hôpital Edouard Herriot, Lyon.
J Chir (Paris). 1993 Apr;130(4):161-4.
Vascular accidents during celioscopy are rare but potentially serious. Arterial injuries usually involve the aortic bifurcation and are generally recognized and treated as emergencies. In the present case, a transfixing wound of the right common iliac artery provoked by a trocar during gynecological celioscopy in a 36 year old woman was diagnosed secondarily, the posterior orifice being unrecognized during laparotomy to control hemorrhage. A false iliac artery aneurysm was detected 2 months later when she presented signs of a compressive retroperitoneal hematoma confirmed by arteriography and scan images. The common iliac artery was ligatured through a right retroperitoneal approach with extra-anatomical revascularization by a crossed iliofemoral venous shunt. The postoperative course was uncomplicated apart from a right cruralgia sequela. Immediate circumferential dissection for treatment of aortic bifurcation injuries is recommended, to avoid missing a transfixing wound, and to allow direct restoration usually by simple suture. In contrast, secondary treatment is complex, raises problems of arterial reconstruction, and cannot always prevent functional sequelae.
腹腔镜检查期间发生的血管意外很少见，但可能很严重。动脉损伤通常累及主动脉分叉，一般会被作为紧急情况识别并处理。在本病例中，一名36岁女性在妇科腹腔镜检查期间，一根套管针导致右侧髂总动脉贯通伤，该损伤在剖腹手术控制出血时未被识别后孔，而是在术后才被诊断出来。2个月后，当她出现压迫性腹膜后血肿的体征时，经动脉造影和扫描图像证实发现了假性髂动脉瘤。通过右侧腹膜后入路结扎髂总动脉，并通过交叉髂股静脉分流进行解剖外血管重建。除了右侧腿痛后遗症外，术后过程顺利。建议立即进行环形解剖以治疗主动脉分叉损伤，以避免遗漏贯通伤，并通常通过简单缝合进行直接修复。相比之下，二期治疗很复杂，会引发动脉重建问题，并且并不总能预防功能后遗症。
