目的 探讨胰头癌侵犯肠系膜上动脉时行根治性切除的可行性。方法 采用联合将受侵犯的肠系膜上动脉一并切除的胰十二指肠切除术，肠系膜上动脉断端与腹主动脉端侧吻合方式重建。 结果 患者术后恢复顺利，已随访14个月，仍存活。 结论 肠系膜上动脉侵犯的胰头癌仍可行扩大的胰十二指肠切除术，并可延长患者的生存时间和提高生活质量。
ObjectiveTo explore the feasibility and safety of modified semi-ex vivo small intestinal autotransplantation (IAT) in patients with distal cholangiocarcinoma (CC) involving mesenteric root. MethodThe clinicopathologic data of the patient with relapse after CC surgery admitted to Sichuan Provincial People’s Hospital on October 2022 were retrospectively analyzed. ResultsThe patient was a 40 years old male. The preoperative imaging showed that the superior mesenteric artery (SMA) and jejunal artery was surrounded by the tumor. The preoperative condition was good and the heart, lung, liver, and kidney functions were normal. The patient could tolerate surgery, then the modified semi-ex vivo IAT was performed. The patient recovered well after surgery and discharged on the 14th postoperative day. The postoperative pathological diagnosis result showed that it was CC. The patient was well and without recurrence or metastasis during following-up in the outpatient service for 5 months until April 2023. ConclusionsFrom the retrospective analysis of this case, it can be realized that the modified semi-ex vivo IAT for patients with tumor involving themesenteric root, it is safe and feasible. A treatment option can be provided for such patient.
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。
ObjectiveTo introduce the advances in diagnosis and treatment of superior mesenteric artery syndrome (SMAS). MethodsLiteratures about SMAS published in domestic and abroad were collected and reviewed. ResultsSMAS was a rare medical condition characterized by acute or chronic ileus resulting from vascular compression of the third part of the duodenum by superior mesenteric artery. Images of upper gastrointestinal series, CT, MRI, and color Doppler ultrasonography were the major methods of diagnosing the syndrome and the upper gastrointestinal series was the most important. Conservative approaches were usually preferred to the treatment of SMAS. Surgery was performed on symptomatic patients when conservative treatment failed, and duodenojejunostomy was the best surgical procedure. ConclusionAwareness of the clinical and imaging features may be helpful to diagnosis and treatment of SMAS, and reasonable therapy shall include etiological treatment and relief of the obstruction by conservative treatment or surgery.
目的 探讨血管介入治疗在急性动脉缺血性肠病早期阶段的价值及应用方法。方法 笔者所在医院2005年8月至2011年12月期间共收治急性动脉缺血性肠病患者9例，其中2008年以前的6例行传统开腹手术治疗，2008年以后的3例患者，在短期内确诊并及时进行了溶栓或取栓治疗。结果 开腹手术治疗的6例患者中，行单纯肠系膜上动脉取栓1例，单纯坏死肠管切除3例，肠系膜上动脉取栓加坏死肠管切除2例；手术后1周内死亡2例（死于多脏器功能衰竭），半年后因短肠综合征死亡1例。行介入治疗的3例患者中，行经导管溶栓治疗2例，球囊取栓加溶栓治疗1例；术后均恢复良好，顺利出院； 术后分别随访6个月、9个月和2年，其中1例术后9个月因脑梗塞死亡。结论 血管介入治疗在急性动脉缺血性肠病的早期诊治方面具有明显的优势，一旦有可疑患者，应迅速进行影像学和血液学方面的检查以明确诊断，非创伤性血管成像技术（CTA）和血管造影（DSA）被认为是最有价值的诊断方法。明确诊断后，专业的血管外科医师的早期干预可以明显改善患者的预后。
Objective To explore the feasibility of clinical application of hepatic artery （HA） or proper hepatic artery （PHA） anastomosing with superior mesenteric artery （SMA） and internal iliac vein （IIV） anastomosing with superior mesenteric vein （SMV） or portal vein （PV） in the extended pancreaticoduodenectomy combined with vascular resection．Methods The HA，PHA，SMA， SMV， PV， and IIV were dissected on 20 adult corpses， and the length， thickness，and lumen diameter of blood vessels were measured and compared with the results of multislice spiral CT scan，magnetic resonance angiography，or color Doppler in 25 patients with pancreatic head carcinoma．The extended pancreaticoduodenectomy was carried out on 5 patients of pancreatic head carcinoma with vascular invasion according to the mathcing results，and the reconstructions of HA or PHA with SMA and IIV with SMV or PV were performed．Results According to autopsy，HA-PHA was （5.50±1.50） cm in length，（0.20±0.01） mm in thickness，（5.02±1.32） mm in lumen diameter；and SMA was （4.00±1.00） cm in length，（0.21±0.01） mm in thickness，（6.05±1.06） mm in lumen diameter．The lumen diameter of left IIV，right IIV，and PV or SMV was （11.06±0.16） mm，（11.10±0.13） mm，and （11.56±0.20） mm，respectively．The thickness of left IIV，right IIV，and PV or SMV was （0.10±0.01） mm，（0.10±0.02） mm，and （0.10±0.02） mm，respectively．The multislice spiral CT scan，magnetic resonance angiography，color Doppler，and selective arteriography in vivo showed that the thickness and lumen diameter of HA-PHA and SMA were wider （0.1 mm and 0.3 mm） than those of the autopsy results，and there were no statistic significances （P＞0.05），but the length of HA-PHA was longer （1－2 cm） than that of SMA，and there was statistic significance （P＜0.05）. The survival of 5 patients with extended pancreaticoduodenectomy combined with PHA or SMA and IIV-PV/SMV resection and reconstruction was longer than that of palliative surgery patients or giving-up patients at the same period，and no long-term complications occurred．Conclusions The vascular invasion of pancreatic head carcinoma is not an absolute contraindication of radical pancreaticoduodenectomy．The survival of 5 patients with vascular invasion of pancreatic head carcinoma in this group is prolonged by extended pancreaticoduodenectomy combined with vascular resection and reconstruction as compared with palliative surgery group at the same period．HA，PHA，and IIV are the best autologous vascular alternative materials without more complications． Being familiar with regional anatomy will guide the surgeons in extended pancreaticoduodenectomy.
目的总结急性肠系膜上动脉缺血性疾病的外科治疗经验。 方法对黄石市中心医院2002年1月至2013年6月期间收治的41例急性肠系膜上动脉缺血性疾病患者的临床资料进行回顾性分析。 结果41例急性肠系膜上动脉缺血性疾病患者中，行手术治疗40例（术中死亡2例），行介入溶栓治疗1例。术后出现短肠综合征9例，死亡19例。出院后27例患者获访，随访时间为1周～2年（平均随访时间为1.4年）。随访期间，因家属放弃治疗而于家中死亡7例，转院后于他院死亡4例，3例未愈或复发，13例痊愈（1例行介入溶栓治疗）。 结论急性肠系膜上动脉缺血性疾病的不同进展阶段其临床特征有所差异，术前CT血管造影（CTA）检查的意义重大。早期诊断、早期治疗、根据病情不同阶段选择合适的治疗方案（手术、介入治疗、药物治疗等）是降低死亡率的关键。