目的 探讨肠系膜上动脉压迫综合征的诊断和治疗方法。
方法 对笔者所在医院2003年8月至2010年8月期间收治的16例肠系膜上动脉压迫综合征患者的临床资料进行回顾性分析。
结果 16例肠系膜上动脉压迫综合征患者的临床表现主要为反复发作性进食后上腹部胀痛或隐痛、呕吐且呕吐后症状可缓解(12例),恶心、反酸及嗳气(13例),饭后饱胀感或腹胀(16例),以及食欲不振(13例)。16例患者均行上消化道造影检查明确诊断;3例行腹部彩色多普勒超声检查符合诊断;4例行CT检查排除十二指肠周围占位性病变。16例患者均先行非手术治疗,其中10例患者的腹痛缓解,呕吐消失,好转出院;另6例因治疗无效而行手术治疗,其中行Treitz韧带松解加十二指肠空肠侧侧吻合术2例,行十二指肠空肠Roux-en-Y吻合术3例,行胃大部分切除、胃空肠吻合术(BillrothⅡ式)1例。术后除1例行Treitz韧带松解加十二指肠空肠侧侧吻合术的患者仍有间断腹胀伴恶心外,其余患者均痊愈。
结论 肠系膜上动脉压迫综合征主要表现为上腹部胀痛、呕吐、食欲不振及消瘦,确诊依赖于上消化道造影。对其治疗首选非手术治疗,对非手术治疗无效者可采用手术治疗,其中十二指肠空肠Roux-en-Y吻合术是一种有效、易行的手术方式。
Citation:
郑见宝,孙学军,王炜,张仕运,刘栋,陈南征,张超. Diagnosis and Treatment of Superior Mesenteric Artery Syndrome. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(3): 310-312. doi:
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Crowther MA, Webb PJ, Eyre-Brook IA. Superior mesenteric artery syndrome following surgery for scoliosis[J]. Spine (Phila Pa 1976), 2002, 27(24): E528-E533.
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Wilkie DPD. Chronic duodenal ileus[J]. Am J Med Sci, 1927, 173(5): 643-649.
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Ortiz C, Cleveland RH, Blickman JG, et al. Familial superior mesenteric artery syndrome[J]. Pediatr Radiol, 1990, 20(8): 588-589.
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Biank V, Werlin S. Superior mesenteric artery syndrome in children: a 20-year experience[J]. J Pediatr Gastroenterol Nutr, 2006, 42(5): 522-525.
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Derrick JR, Fadhli HA. Surgical anatomy of the superior mesenteric artery[J]. Am Surg, 1965, 31: 545-547.
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刘勇, 罗羽宏. 肠系膜上动脉压迫综合征的诊疗进展[J]. 中国普外基础与临床杂志, 2011, 18(2): 225-228.
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兰明银, 刘瑜, 周猛, 等. 肠系膜上动脉压迫综合征的诊断和治疗[J]. 腹部外科, 2009, 22(4): 221-222.
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邱勇, 朱丽华, 朱泽章, 等. 脊柱侧凸矫形术后并发肠系膜上动脉综合征[J]. 中华骨科杂志, 2002, 22(4): 223-225.
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Merrett ND, Wilson RB, Cosman P, et al. Superior mesenteric artery syndrome: diagnosis and treatment strategies[J]. J Gastrointest Surg, 2009, 13(2): 287-292.
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Chan KH, Mak SW, Cheah YL. Successful nutritional therapy for superior mesenteric artery syndrome[J]. Singapore Med J, 2012, 53(11): e233-e236.
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邹小明. 手术治疗肠系膜上动脉综合征的术式探讨[J]. 中国实用外科杂志, 2006, 26(6): 471-472.
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陈历恒, 蒋晓忠, 杜一平, 等. 肠系膜上动脉压迫综合征的诊断及术式选择评价[J]. 中国普外基础与临床杂志, 2008, 15(7): 518-521.
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13. |
张豫峰, 郭永强, 陈壬寅. 肠系膜上动脉压迫综合征腹腔镜手术十例[J]. 中华普通外科杂志, 2011, 26(6): 512-513.
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Lee TH, Lee JS, Jo Y, et al. Superior mesenteric artery syndrome:where do we stand today?[J]. J Gastrointest Surg, 2012, 16(12):.
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Alnaami MY. Robotic management of superior mesenteric artery syndrome[J]. Surg Laparosc Endosc Percutan Tech, 2012, 22(3): e144-e147.
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-2211.
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- 1. Crowther MA, Webb PJ, Eyre-Brook IA. Superior mesenteric artery syndrome following surgery for scoliosis[J]. Spine (Phila Pa 1976), 2002, 27(24): E528-E533.
- 2. Wilkie DPD. Chronic duodenal ileus[J]. Am J Med Sci, 1927, 173(5): 643-649.
- 3. Ortiz C, Cleveland RH, Blickman JG, et al. Familial superior mesenteric artery syndrome[J]. Pediatr Radiol, 1990, 20(8): 588-589.
- 4. Biank V, Werlin S. Superior mesenteric artery syndrome in children: a 20-year experience[J]. J Pediatr Gastroenterol Nutr, 2006, 42(5): 522-525.
- 5. Derrick JR, Fadhli HA. Surgical anatomy of the superior mesenteric artery[J]. Am Surg, 1965, 31: 545-547.
- 6. 刘勇, 罗羽宏. 肠系膜上动脉压迫综合征的诊疗进展[J]. 中国普外基础与临床杂志, 2011, 18(2): 225-228.
- 7. 兰明银, 刘瑜, 周猛, 等. 肠系膜上动脉压迫综合征的诊断和治疗[J]. 腹部外科, 2009, 22(4): 221-222.
- 8. 邱勇, 朱丽华, 朱泽章, 等. 脊柱侧凸矫形术后并发肠系膜上动脉综合征[J]. 中华骨科杂志, 2002, 22(4): 223-225.
- 9. Merrett ND, Wilson RB, Cosman P, et al. Superior mesenteric artery syndrome: diagnosis and treatment strategies[J]. J Gastrointest Surg, 2009, 13(2): 287-292.
- 10. Chan KH, Mak SW, Cheah YL. Successful nutritional therapy for superior mesenteric artery syndrome[J]. Singapore Med J, 2012, 53(11): e233-e236.
- 11. 邹小明. 手术治疗肠系膜上动脉综合征的术式探讨[J]. 中国实用外科杂志, 2006, 26(6): 471-472.
- 12. 陈历恒, 蒋晓忠, 杜一平, 等. 肠系膜上动脉压迫综合征的诊断及术式选择评价[J]. 中国普外基础与临床杂志, 2008, 15(7): 518-521.
- 13. 张豫峰, 郭永强, 陈壬寅. 肠系膜上动脉压迫综合征腹腔镜手术十例[J]. 中华普通外科杂志, 2011, 26(6): 512-513.
- 14. Lee TH, Lee JS, Jo Y, et al. Superior mesenteric artery syndrome:where do we stand today?[J]. J Gastrointest Surg, 2012, 16(12):.
- 15. Alnaami MY. Robotic management of superior mesenteric artery syndrome[J]. Surg Laparosc Endosc Percutan Tech, 2012, 22(3): e144-e147.
- 16. -2211.