Ayloo Subhashini M, Masrur Mario A, Bianco Francesco M, Giulianotti Pier C
Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
J Laparoendosc Adv Surg Tech A. 2011 Nov;21(9):841-4. doi: 10.1089/lap.2011.0070. Epub 2011 Aug 5.
Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare condition characterized by vascular compression of the duodenum that leads to intestinal obstruction. While there have been a few recent case reports of laparoscopic duodenojejunostomy performed as an option for surgical treatment, the role of the da Vinci(®) robot in superior mesenteric syndrome has been underestimated. The authors report a robotic Roux-en-Y duodenojejunostomy for the treatment of SMA syndrome.
A 39-year-old man with a history of Amyotrophic lateral sclerosis presented with an upper gastrointestinal obstruction with distended abdomen. A computed tomography scan showed a transition in the third portion of the duodenum where the SMA vessels crossed over, with a decompressed jejunum. He was identified as a candidate for a duodenojejunostomy. The da Vinci Surgical System was used to mobilize the colon and duodenum, and a Roux-en-Y duodenojejunostomy was performed with hand-sewn anastomosis.
There were no intraoperative complications. The blood loss was minimal and operative time was 120 minutes. The postoperative course was uneventful with resolution of intestinal obstruction.
Robotic Roux-en-Y duodenojejunostomy as a surgical option for treatment of SMA syndrome is safe, feasible, and a valid alternative to open surgery with the added benefits of a minimally invasive approach.
肠系膜上动脉（SMA）综合征，也称为威尔基综合征，是一种罕见的疾病，其特征是十二指肠受到血管压迫导致肠梗阻。虽然最近有一些关于腹腔镜十二指肠空肠吻合术作为手术治疗选择的病例报告，但达芬奇（®）机器人在肠系膜上动脉综合征中的作用一直被低估。作者报告了一例机器人辅助的Roux-en-Y十二指肠空肠吻合术治疗SMA综合征。
一名39岁的肌萎缩侧索硬化症患者出现上消化道梗阻伴腹部膨隆。计算机断层扫描显示十二指肠第三段在肠系膜上动脉血管交叉处出现移行，空肠扩张。他被确定为十二指肠空肠吻合术的候选者。使用达芬奇手术系统游离结肠和十二指肠，并进行手工缝合吻合的Roux-en-Y十二指肠空肠吻合术。
术中无并发症。失血极少，手术时间为120分钟。术后病程顺利，肠梗阻缓解。
机器人辅助的Roux-en-Y十二指肠空肠吻合术作为治疗SMA综合征的手术选择是安全、可行的，是开放手术的有效替代方法，具有微创方法的额外优势。
