完全腹腔镜腹主-双股动脉人工血管旁路术的临床应用

Total laparoscopic aortobifemoral bypass

目的探讨完全腹腔镜腹主-双股动脉人工血管旁路术的可行性和安全性。方法 2011年5月收治1例主髂动脉闭塞患者,行完全腹腔镜腹主动脉-双股动脉人工血管旁路术。患者耻骨上方做切口,置入10mm Trocar建立气腹与腹腔镜通道,左右腹直肌外缘置入1个12mm Trocar和1个5mm Trocar,导入操作器械。左肋缘下另置入1个5mm Trocar,导入把持钳。采用"围裙"技术隔离小肠。游离腹主动脉。在肠系膜下动脉下方阻断腹主动脉,行人工血管-腹主动脉端侧吻合。吻合成功后,将人工血管分支经皮下隧道引出至双侧腹股沟切口。开放手术行人工血管-双股动脉端侧吻合。结果手术时间450min,腹腔镜下血管吻合时间70min。术中失血量约650ml。随访14个月,人工血管通畅。结论完全腹腔镜腹主-双股动脉人工血管旁路术是安全、可行的。

Objective To study the feasibility and safety of total laparoscopic aortobifemoral bypass. Methods May 2011, the patient diagnosed as aortoiliac occlusion was performed total laparoscopiclaortobifemora bypass. One 10mm Trocar for laparoscope was located above the pubic symphysis. One 12mm Trocar and one 5mm troca was placed at external edge of the right and left rectus. One 5mm troca was located at the left costal marginfor grasper.The bowel was isolated with apron technique. The abdominal aortic artery was diveded and clampped under the inferior mesenteric artery . The graft-aorto end-to-side laparoscopic anastomosis was performed with running suture. The prosthesis was led through the subcutaneous tunnel to the right and left groin incision. Prosthesis was sutured to the femoral artery end-to-side with open surgery technique. Results The operative time was 450 minutes. The laparoscopical anastomosis time was 70 minutes. Blood loss was 650ml. Prosthesis was patent and no complication were found within 14 months after operation. Conclusions Total laparoscopic aortobifemoral bypass is feasible and safety.