十二指肠环形引流术治疗肠系膜上动脉综合征的评估
Assessment of duodenal circular drainage in treatment of superior mesenteric artery syndrome.
作者信息
Yang Wei-Liang, Zhang Xin-Chen
机构信息
Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China.
出版信息
World J Gastroenterol. 2008 Jan 14;14(2):303-6. doi: 10.3748/wjg.14.303.
AIM
To assess the clinical value of duodenal circular drainage for superior mesenteric artery syndrome (SMAS).
METHODS
Forty-seven cases of SMAS were treated with duodenal circular drainage from 1959 to 2001. Clinical data were analyzed retrospectively.
RESULTS
In this group, good effects were achieved in 39 cases treated with duodenal circular drainage after 2-15 years of follow-up. The other eight cases were first treated with anterior repositioning of the duodenum (two cases), duodenojejunostomy (five cases), subtotal gastrectomy and billroth II gastrojejunostomy (one case), but vomiting was not relieved until duodenal circular drainage was performed again. A follow-up study of 8-10 years revealed satisfactory results in these eight patients.
CONCLUSION
In SMAS, if the reversed peristalsis is strong and continuous, and vomiting occurs frequently, the symptom can not be relieved even if the obstruction of duodenum is removed surgically. The key treatment is the relief of reversed peristalsis. The duodenal circular drainage can resolve the drainage direction of duodenal content, thus relieving the symptom of vomiting.
目的
评估十二指肠环形引流术治疗肠系膜上动脉综合征（SMAS）的临床价值。
方法
回顾性分析1959年至2001年采用十二指肠环形引流术治疗的47例SMAS患者的临床资料。
结果
该组中，39例行十二指肠环形引流术的患者经2至15年随访取得良好效果。另外8例患者最初分别接受十二指肠前移术（2例）、十二指肠空肠吻合术（5例）、胃大部切除术及毕Ⅱ式胃空肠吻合术（1例），但直至再次行十二指肠环形引流术后呕吐症状才得以缓解。对这8例患者进行8至10年的随访研究，结果令人满意。
结论
在SMAS中，如果逆蠕动强烈且持续，频繁发生呕吐，即使手术解除十二指肠梗阻，症状也无法缓解。关键治疗在于解除逆蠕动。十二指肠环形引流术可解决十二指肠内容物的引流方向问题，从而缓解呕吐症状。
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