摘要
目的探讨完全腹腔镜下主一双股动脉旁路术治疗主、髂动脉硬化闭塞症的安全性和可行性。方法2008年11月～2012年11月，完全腹腔镜下主一双股动脉旁路术连续治疗7例主、髂动脉硬化闭塞症。7例均为男性，年龄52—70岁，平均60．6岁。Rutherford分级3级5例，4级I例，5级1例。主、髂病变TASC分级C级2例，D级5例。全麻，先用完全腹腔镜技术经左侧结肠后肾后入路游离肾下腹主动脉，再将“Y”形涤纶人工血管近端与之行端侧吻合，人工血管远端经腹膜后隧道引出至相应侧腹股沟，直视下分别与双侧股动脉吻合。结果5例顺利完成腹腔镜下主一双股动脉旁路术，2例中转开腹（肠系膜下动脉断端的钛夹脱落出血1例，结肠损伤1例）。手术时间420～840rain（中位数585min），主动脉吻合时间40～150min（中位数65rain），术中出血量400—1500ml（中位数800m1）。未中转的5例均在术后12—40h恢复进食，术后顺利康复出院。结肠损伤患者术后结肠漏二次开腹手术，结肠漏治愈，术后46天死于呼吸衰竭。一过性左肾积水1例，治愈。吻合口近端腹主动脉残留重度狭窄1例行支架治疗治愈。无症状的部分左肾梗死1例。6例随访2—51个月，平均11．2月，均健在，超声随访移植物均通畅，静息痛和间歇跛行症状均消失。结论完全腹腔镜下主一双股动脉旁路术治疗主、髂动脉硬化闭塞症是安全、可行的。在学习曲线中及时中转保证手术安全是必要的。
Objective To evaluate the safety and feasibility of total laparoscopic aortobifemoral bypass surgery for aortoiliac occlusive disease （AIOD）. Methods From November 2008 to November 2012, 7 patients of severe AIOD underwent total laparoscopic aortobifemoral bypass in our hospital. The 7 patients were all male, with a mean age of 60. 6 （ range, 52 - 70 ）. Rutherford classification： 5 cases were class 3, 1 case was class 4 and 1 case was class 5. TASC classification of lesion： 2 cases were TASC C and 5 cases were TASC D. Under general anesthesia with a total laparoscopic technique, the infrarenal aorta was exposed by a transperitoneal left retrocolic retrorenal approach, and end-to-side aorta-prosthesis anastomosis was done to a Y-shaped Preclotted Dacron graft, then the two prosthetic limbs were pulled out retroperitoneally to the ipsilateral groin, prosthesis-femoral artery anastomoses were performed with open technique. Results Five operations were performed successfully, and 2 cases were converted to open surgery （ 1 case of bleeding caused by titanium clip at inferior mesenteric artery, 1 case of colonic injury）. Median operation time was 585 min （range, 420 -840 min） ; median blood loss was 800 ml （range, 400 - 1500 ml） ; median aortic anastomosis time was 65 min （ range, 40 - 150 min）. The 5 successful cases resumed diet 12 to 40 h after the surgery and recovered soon. The patient suffering from colonic injury underwent a second open surgery and died 46 d after the surgery due to respiratory failure. One patient suffering from transient hydronephrosis recovered after treatment. Two patients who suffered juxtarenal aortoiliac occlusion underwent Fogarty catheter thromboembolectomy during laparoscopic surgery ： one had an aortic residual stenosis proximal to anastomosis site, and restored after endovascular stenting on 12th day postoperatively, the other had a small partial asymptomatic left renal infarction which was found by enhanced CT. Six cases were followed up for 2 to 51 months （ average, 11.2 months） and M1 were alive. Ultrasound examination revealed that all the grafts were unobstructed. Symptoms like rest pain and intermittent elaudication all disappeared. Conclusions Total laparoscopic aortobifemoral bypass surgery is a safe and feasible procedure for the treatment of AIOD. Conversion in time is prerequisite for ensuring the safety of the surgery.
出处
《中国微创外科杂志》
CSCD
2013年第9期798-802,共5页
Chinese Journal of Minimally Invasive Surgery
基金
北京市卫生系统高层次卫生技术人才(学科骨干)培养计划(No.2009.3-59)
作者简介
通讯作者，E-mail：guyq66@yahoo．cn
