腹腔镜技术在主股动脉转流手术中的应用  

Laparoscopic aortofemoral bypass for diffuse aortoiliac occlusive diseases

作　　者：朱越锋[1] 沈来根[1] 杨进[1] 刘震杰[1] Ralf Kolvenbach Sergej Wassiljew 

机构地区：[1]浙江大学医学院附属邵逸夫医院普外科、血管外科,杭州310016 [2]Department ofVascular Surgery and Endovascular Therapy, Augusta Hospital and Catholic Clinics, Dusseldorf, Germany 40472

出　　处：《中华普通外科杂志》2012年第11期879-882,共4页Chinese Journal of General Surgery

基　　金：浙江省医药卫生科技计划基金资助项目（2012KYA113）;浙江省教育厅科研计划基金资助项目（Y201224884）

摘　　要：目的 探讨腹腔镜主股动脉转流术治疗主髂闭塞性疾病的可行性和安全性.方法 回顾性分析18例主髂闭塞性疾病患者应用腹腔镜主股动脉转流术的治疗情况,评价手术的可行性、解剖要点、术中主动脉阻断时间、出血量、ICU停留时间等.结果 18例中,17例接受完全腹腔镜主股动脉转流手术患者获得成功.1例主双髂动脉闭塞患者因腹主动脉壁严重钙化而中转开放手术.平均手术时间（280±57） min,平均主动脉阻断时间（117 ±32） min,术中平均失血（524±45） ml,平均ICU监护时间（1.0±1.2）d,平均术后进食时间（3±3）d,平均术后住院时间（10±5）d.术后发生心肌梗死1例、肺部感染2例均在ICU监护治疗后好转,发生人工血管内血栓形成1例,再次手术取栓,术后通畅.本组18例患者均获随访,随访时间3～ 27个月,平均随访时间（18±8）个月.人工血管均保持通畅.结论 腹腔镜主股动脉转流手术治疗主髂动脉闭塞性疾病是安全可行的,微创手术有利于患者恢复.Objective To investigate the feasibility and safety of laparoscopic aortobifemoral bypass （LABF） for diffuse aortoiliac occlusive diseases.Methods Clinical data of 18 cases who underwent LABF were retrospectively analyzed.The intraoperative procedures and postoperative outcome were evaluated.Results LABF was performed successfully in 17 of 18 patients.The mean operation time was （280 ±57） minutes,with a mean aortic cross-clamp time of （117 ±32） minutes.Estimated blood loss was（524 ±45） ml.Mean ICU stay was （ 1.0 ± 1.2） days.The mean postoperative hospital stay was （ 10 ±5） days.Mean time to resume diet was （3 ± 3 ） days.Postoperative myocardial infarction developed in 1 case,lung infection in 2 cases.There was no perioperative mortality.Graft thrombosis developed in 1 case and embolectomy surgery was successfully performed.All patients were followed up from 3 to 27 months,with mean follow-up of （18 ± 8） months,grafts were all patent.Conclusions Laparoscopic aortic bypass is feasible and miniinvasive in patients with diffuse aortoiliac occlusive disease.Short-term outcomes are comparable to those with open conventional aortic bypass.

关 键 词：动脉闭塞性疾病 血管外科手术 腹腔镜 

分 类 号：R654.3[医药卫生—外科学]