完全腹腔镜髂-股动脉人工血管旁路术一例

目的探讨完全腹腔镜髂-股动脉人工血管旁路术的可行性和安全性。方法 2010年5月收治外伤后髂动脉闭塞患者1例,行完全腹腔镜髂总动脉-股动脉人工血管旁路术。患者取仰卧位,脐部下缘10mm切口建立气腹与腹腔镜通道,另置入2个5mmTrocar和1个12mmTrocar导入操作器械。经腹腔入路,游离右髂总动脉。周身肝素化（1mg/kg）后阻断右髂总动脉,远端夹闭后离断。置入膨体聚四氟乙烯人工血管,在腹腔镜下行人工血管-右髂总动脉端端吻合术。吻合成功后,将人工血管经皮下隧道引出至右腹股沟切口。开放手术行人工血管-右股动脉端侧吻合。结果手术过程顺利,手术时间250min,术中髂总动脉阻断时间55min,吻合时间40min,术中失血量300ml。随访1年,人工血管通畅。结论完全腹腔镜髂-股动脉人工血管旁路术是安全、可行的。熟练的腹腔镜血管吻合技术是手术成功的关键。

Total laparoscopic ilio-femoral bypass: case report

Objective To study the feasibility and safety of total laparoscopic ilio-femoral bypass.Methods May 2010,a 41-year-old male with post traumatic iliac artery occlusion was performed total laparoscopic ilio-femoral bypass.A 10 mm trocar was introduced,and the abdominal cavity was explored with a scope,and then two 5 mm trocars and a 12 mm trocar were introduced.Blocking the right common iliac artery after heparinization（1 mg/kg）,and distal occlusion after the amputation.The prosthesis was sutured to the right common iliac artery end to end using total laparoscopic thechnique.The prosthesis was led through the subcutaneous tunnel to the right groin incision.Prosthesis was sutured to the right femoral artery end to side with open surgery technique.Results The operative time was 250 minutes.Iliac artery clamping time measured to unclamping of the first prosthetic limb was 55 minutes.Ilio-prosthesis-femoral anastomosis was 40 minutes.Blood loss 300 ml.The duration before ambulation,flatus,liquid food intake,was 13 h,24 h,and 36 h.Prosthesis was patent and no complication were found within 12 months after operation.Conclusions Total laparoscopic ilio-femoral bypass is feasible and safety.Skilled laparoscopic vascular anastomosis is the key to successful operation.