Dion Y M, Gracia C R, Estakhri M, Demalsy J C, Douville Y, Piccinini E, Stancanelli V
Department of Surgery, Laval University, Québec, Canada.
Surg Laparosc Endosc. 1998 Jun;8(3):165-70.
The main purpose of this study is to evaluate the feasibility of totally laparoscopic aortobifemoral bypass for occlusive aortoiliac disease. Ten patients who had incapacitating claudication have been included to date in this investigation. We have designed a transabdominal retroperitoneal technique that allows performance of the procedure without the problems associated with retraction of intraperitoneal organs. During the study, surgery time decreased from 510 to 245 min. Mean total aortic clamping time was 121 min, and the mean time required to perform the aortic anastomosis was 66 min. Mean blood loss was 820 ml. Three patients needed conversion. Postoperative complications developed in three patients. One had an aortoureteral fistula, which needed reoperation; one experienced complications related to a retroaortic left renal vein; and the third had a mild compartment syndrome of the right leg. Totally laparoscopic aortobifemoral bypass is feasible. Laparoscopic aortobifemoral bypass appears to ease the patient's postoperative course and could become in the not so distant future part of the repertoire of the surgeon performing vascular surgery.
本研究的主要目的是评估完全腹腔镜下腹主动脉-双股动脉旁路移植术治疗闭塞性主髂动脉疾病的可行性。迄今为止，已有10例因严重间歇性跛行而行动不便的患者纳入本研究。我们设计了一种经腹腹膜后技术，该技术可在不出现与腹腔内器官牵拉相关问题的情况下进行手术。在研究过程中，手术时间从510分钟降至245分钟。平均主动脉阻断时间为121分钟，主动脉吻合平均所需时间为66分钟。平均失血量为820毫升。3例患者需要中转开腹。3例患者出现术后并发症。1例发生主动脉-输尿管瘘，需要再次手术；1例出现与主动脉后左肾静脉相关的并发症；第3例出现右下肢轻度骨筋膜室综合征。完全腹腔镜下腹主动脉-双股动脉旁路移植术是可行的。腹腔镜下腹主动脉-双股动脉旁路移植术似乎可使患者术后恢复过程更为轻松，并且在不久的将来可能会成为血管外科医生手术技能的一部分。
