完全腹腔镜手术治疗平肾腹主动脉闭塞症

摘要

Objective To explore the feasibility and effectiveness of totally laparoscopic surgery for the treatment of juxtarenal aortic occlusion. Methods Clinical data on 2 patients with juxtarenal aortic occlusion were retrospectively analysed. Results All the two patients with juxtarenal aortic occlusion underwent aortic thrombectomy followed with aortofemoral bypass grafting under total laparoscopy with general anesthesia. The operations were successful. Intraoperative graft embolisation was found in one patient and embolectomy was immediately done.Postoperative renal infarction lesion and residual aortic stenosis were found in the other patient. Aortic angioplasty and stenting was done before discharge. The two patients had uneventful postoperative recovery. The graft was patent in two patients through the follow-up of 14 and 10 months respectively. Conclusions Totally laparoscopic surgery is feasible and effective for the treatment of juxtarenal aortic occlusion. Endovascular techniques are required to combine with laparoscopy for better outcome.%目的：探讨完全腹腔镜手术治疗平肾腹主动脉闭塞症的可行性及疗效。方法对2例病人的临床资料进行回顾性分析。结果2例病人均诊断为平肾动脉主髂动脉闭塞症。全麻后行完全腹腔镜下腹主动脉切开，Fogarty导管取栓及腹主动脉-股动脉人工血管转流术。2例手术均成功完成。1例术中人工血管栓塞，行人工血管切开取栓；1例术后CTA发现左肾梗塞灶及腹主动脉残余狭窄，再次行腹主动脉支架成形术。患者术后恢复顺利，分别随访14及10个月，人工血管保持通畅。结论完全腹腔镜手术治疗平肾腹主动脉闭塞症创伤小，疗效好，值得推广。结合介入技术可以术中监测疗效，及时进行合理治疗。