Barbera L, Mumme A, Metin S, Zumtobel V, Kemen M
Department of Surgery, St Josef Hospital, Ruhr-Universität, Bochum, Germany.
J Vasc Surg. 1998 Jul;28(1):136-42. doi: 10.1016/s0741-5214(98)70209-5.
The study objective was to apply laparoscopic techniques to conventional bypass procedures for aortoiliac occlusive disease.
From October 1995 to August 1997, we performed seven iliofemoral (IFB), five unilateral aortofemoral (UAFB), and 11 aortobifemoral (AFB) bypass procedures and one aortic endarterectomy (TEA) totally laparoscopic. A transabdominal approach with pneumoperitoneum was preferred, and only laparoscopic vascular instruments were used. Endoscopic intervention followed principles of vascular surgery. As in open surgery, we used Dacron grafts and polypropylene sutures.
Twenty procedures were carried out totally laparoscopic; four conversions to open surgery were necessary. Severe complications included one postoperative respiratory failure requiring ventilatory support for four days, and one iliac vein lesion with subsequent open surgery. Mean operating time was 258 +/- 49 minutes for IFB, 218 +/- 54 minutes for UAFB, 279 +/- 69 minutes for AFB, and 290 minutes for aortic TEA. Mean blood loss was 92 +/- 49 ml for IFB, 390 +/- 316 ml for UAFB, 563 +/- 516 ml for AFB, and 100 ml for aortic TEA. Mean postoperative stay was 7.4 days for IFB, 7.8 days for UAFB, and 10.1 days for AFB. After the aortic TEA, the patient was discharged on day 6. At control examination all grafts were patent; two patients had mild claudication because of one progressive disease and one distal suture stenosis.
Laparoscopic vascular surgery for aortoiliac occlusive disease is feasible, safe, and effective. At the beginning, a cooperation between experienced laparoscopists and vascular surgeons is needed to overcome procedural challenge, because operating time and conversion rate decrease with growing experience. The advantages observed in the majority of our patients were minimal tissue trauma, decreased blood loss, and faster postoperative recovery when compared with patients who had open aortic surgery at our institution. Further evidence has to be gained by clinical trials to define the role of laparoscopic vascular surgery for aortoiliac occlusive disease.
本研究的目的是将腹腔镜技术应用于治疗主髂动脉闭塞性疾病的传统搭桥手术。
1995年10月至1997年8月，我们共进行了7例髂股（IFB）、5例单侧主股（UAFB）和11例主双股（AFB）搭桥手术以及1例主动脉内膜切除术（TEA），均采用全腹腔镜手术。首选经腹入路并建立气腹，仅使用腹腔镜血管器械。内镜干预遵循血管外科原则。与开放手术一样，我们使用涤纶移植物和聚丙烯缝线。
共进行了20例全腹腔镜手术；4例需要转为开放手术。严重并发症包括1例术后呼吸衰竭，需要呼吸机支持4天，以及1例髂静脉损伤，随后进行了开放手术。IFB的平均手术时间为258±49分钟，UAFB为218±54分钟，AFB为279±69分钟，主动脉TEA为290分钟。IFB的平均失血量为92±49毫升，UAFB为390±316毫升，AFB为563±516毫升，主动脉TEA为100毫升。IFB的平均术后住院时间为7.4天，UAFB为7.8天，AFB为10.1天。主动脉TEA术后，患者于第6天出院。在对照检查中，所有移植物均通畅；2例患者因疾病进展和1例远端缝线狭窄而有轻度跛行。
腹腔镜血管手术治疗主髂动脉闭塞性疾病是可行、安全且有效的。开始时，需要经验丰富的腹腔镜医生和血管外科医生合作以克服手术挑战，因为随着经验的增加，手术时间和中转率会降低。与我院接受开放主动脉手术的患者相比，我们大多数患者观察到的优势是组织创伤小、失血量减少和术后恢复更快。需要通过临床试验获得进一步证据，以确定腹腔镜血管手术在主髂动脉闭塞性疾病治疗中的作用。
