Jobe B A, Duncan W, Swanstrom L L
Minimally Invasive Surgery Department, Legacy Portland Hospitals, and Oregon Health Sciences University, Portland, OR, USA.
Surg Endosc. 1999 Jan;13(1):77-9. doi: 10.1007/s004649900904.
On the basis of our previous animal and clinical experience with laparoscopic intra-abdominal vascular reconstructions, and due to the prevalence of abdominal aortic aneurysms (AAA), we have recently broadened our scope to tackle more difficult aortic surgery laparoscopically. We present a case report of our first clinical experience with laparoscopic AAA repair using specialized laparoscopic vascular instrumentation. The patient was an 84-year-old hypertensive male with a 7-cm asymptomatic infrarenal abdominal aortic aneurysm that was discovered incidentally. He presented with postcoronary artery bypass grafting and had moderate chronic obstructive pulmonary disease (COPD). A spiral computed tomograph (CT) angiogram revealed an adequate infrarenal neck and aneurysmal involvement of the proximal iliac arteries. An eight-port transabdominal technique was used with the patient in the supine position. Proximal and distal control was achieved without difficulty. The aneurysm was excluded using endoscopic stapling devices, and an aortobiiliac reconstruction was performed with a 16 x 9-mm bifurcated dacron graft. Estimated blood loss was 1000 ml, and the operative time was approximately 7 hours. The patient was ambulating without assistance on postoperative day 3. Total hospitalization was 7 days (delayed secondarily to postoperative ileus). Minimal quantities of narcotics were required for analgesia. At 6-months follow-up, the patient has palpable peripheral pulses and no complications related to surgery. This case report shows that a completely laparoscopic approach to the abdominal aortic aneurysm is possible using instrumentation specifically designed for laparoscopic vascular surgery. The exact role that laparoscopic techniques will hold in vascular surgery remains to be determined because these procedures are time consuming and technically difficult.
基于我们之前在腹腔镜腹内血管重建方面的动物实验和临床经验，并且由于腹主动脉瘤（AAA）的普遍性，我们最近扩大了范围，以腹腔镜方式处理更具挑战性的主动脉手术。我们报告了首例使用专门的腹腔镜血管器械进行腹腔镜AAA修复的临床经验。患者为一名84岁的男性高血压患者，偶然发现一个7厘米无症状的肾下腹主动脉瘤。他曾接受冠状动脉搭桥手术，患有中度慢性阻塞性肺疾病（COPD）。螺旋计算机断层扫描（CT）血管造影显示肾下颈部足够，近端髂动脉有动脉瘤累及。采用八孔经腹技术，患者仰卧位。近端和远端控制顺利实现。使用内镜吻合器排除动脉瘤，并用16×9毫米分叉涤纶移植物进行主动脉髂动脉重建。估计失血量为1000毫升，手术时间约7小时。患者术后第3天可独立行走。总住院时间为7天（继发于术后肠梗阻）。镇痛所需的麻醉药量极少。在6个月的随访中，患者可触及外周脉搏，无手术相关并发症。本病例报告表明，使用专门为腹腔镜血管手术设计的器械，完全腹腔镜治疗腹主动脉瘤是可行的。腹腔镜技术在血管手术中的确切作用仍有待确定，因为这些手术耗时且技术难度大。
