Gonda, Goldschmied, Vascular Center, Division of Vascular Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Calif, USA.
J Vasc Surg. 2012 Sep;56(3):869-73. doi: 10.1016/j.jvs.2012.04.057. Epub 2012 Jun 27.
Median arcuate ligament syndrome (MALS) is a syndrome associated with chronic abdominal pain and radiographic evidence of celiac artery compression. We compared the evidence for both open and laparoscopic treatment of patients with MALS.
We reviewed the English-language literature between 1963 and 2012. Presenting symptoms, clinical improvement, operative details, and intraoperative and postoperative complications were noted.
A total of 400 patients underwent surgical (open and laparoscopic) treatment for MALS. Three hundred thirty-nine patients reported immediate postoperative symptom relief (85%). Late recurrence of symptoms was reported in 19 patients in the open group (6.8%) and seven patients in the laparoscopic group (5.7%). Eleven out of 121 patients (9.1%) in the laparoscopic group required open conversion secondary to bleeding.
The available evidence demonstrates that both laparoscopic and open ligament release, celiac ganglionectomy, and celiac artery revascularization may provide sustained symptom relief in the majority of patients diagnosed with MALS. The role of arterial revascularization following ligament release remains unclear. The rate of open conversion with the laparoscopic approach is high, but no perioperative deaths have been reported.
中位弓状韧带综合征（MALS）是一种与慢性腹痛和腹主动脉压迫的影像学证据相关的综合征。我们比较了开放手术和腹腔镜手术治疗 MALS 患者的证据。
我们回顾了 1963 年至 2012 年期间的英文文献。记录了患者的主要症状、临床改善情况、手术细节以及术中、术后并发症。
共有 400 例 MALS 患者接受了手术（开放和腹腔镜）治疗。339 例患者报告术后即刻症状缓解（85%）。开放组 19 例（6.8%）和腹腔镜组 7 例（5.7%）患者出现晚期症状复发。121 例腹腔镜组患者中有 11 例（9.1%）因出血需要转为开放手术。
现有证据表明，腹腔镜和开放韧带松解、腹腔神经节切除术和腹主动脉再血管化可能为大多数诊断为 MALS 的患者提供持续的症状缓解。韧带松解后动脉再血管化的作用仍不清楚。腹腔镜治疗的中转开放率较高，但无围手术期死亡病例报告。
