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Samanburður á tveimur aðgerðarleiðum vegna æðakölkunar á kviðarholshluta ósæðar

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Authors
Guðmundur Daníelsson
Halldór Jóhannsson
Páll Gíslason
Jónas Björn Magnússon
Issue Date
1995-12-01

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Other Titles
Retroperitoneal approach to the abdominal aorta for occlusive disease
Citation
Læknablaðið 1995, 81(12):864-6
Abstract
The abdominal aorta can be approached through the peritoneum or retroperitoneally. The aim of this study was to compare these two routes of exposure. Over a 10 year period, between 1979 and 1989, 48 patients were operated on for an aortobifemoral bypass, because of occlusive diseases of aorta or iliac arteries. The retroperitoneal approach was used in 20 cases and 28 were operated by the standard transperitoneal approach. In a non randomized retrospective study the outcome was compared regarding; operation time, blood transfusion during operation, initiation of alimentation, hospitalisation and mortality. All of the patients were operated on by two experienced vascular surgeons. In the retroperitoneal group there were 11 men and 10 women with a mean age of 63,4 years. In the transperitoneal group there were 16 men and 10 women with a mean age of 60,3 years. With the retroperitoneal approach the operating time was 185 min. v. 248 min. for the transperitoneal group (p<0.05). The fasting period after operation was four days for the retroperitoneal group v. five days for the transperitoneal group (p<0.05). The hospitalization was 11 days when the retroperitoneal approach was used v. 15 days for the transperitoneal group (ns). The results of this study indicate that it is advantageous to approach the abdominal aorta through a retroperitoneal route.
Auðvelt er að komast að ósæð gegnum kviðarholið (transperitoneal) en einnig bak við lífhimnu (retroperitoneal). Báðar aðferðir gagnast og eru notaðar á handlækningadeild Landspítalans. Tilgangur rannsóknarinnar var að bera saman þessar tvær aðgerðarleiðir. Frá 1979 til 1989 voru 47 sjúklingar skornir upp vegna þrengsla í ósæð og gerviæð sett inn (aorta bifemoral graft). Farið var bak við lífhimnu hjá 21 sjúklingi (hópur A) og í gegnum kviðarhol hjá 26 sjúklingum (hópur B). Rannsóknin var afturskyggn og ekki slembuð, borinn var saman aðgerðartími, blóðgjafir í aðgerð, fasta eftir aðgerð, sjúkrahúsvist og skurðdauði. Allir sjúklingarnir voru skornir upp af reyndum æðaskurðlæknum. Í hópi A voru 10 karlar og 11 konur með meðalaldur 63,4 ár. í hópi B voru 6 karlar og 10 konur með meðalaldur 60,3 ár. Í hópi A var aðgerðartíminn 185 mínútur en 248 mínútur í hópi B (p<0,05). Hópur A fastaði í fjóra daga eftir aðgerð en hópur B í fimm daga (p<0,05). Sjúklingar í hópi A dvöldu 11 daga á sjúkrahúsinu en sjúklingar í hópi B 15 daga (ns). Niðurstöður rannsóknarinnar benda til þess að fremur ætti að fara bak við lífhimnu kviðarhols við aðgerðir á ósæð.
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