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肠系膜上动脉综合征:肠梗阻的罕见病因。诊断与手术治疗

Superior mesenteric artery syndrome: a rare cause of intestinal obstruction. Diagnosis and surgical management.

作者信息

Yakan Savas, Calıskan Cemil, Kaplan Hasan, Deneclı Ali Galip, Coker Ahmet

机构信息

Department of Surgery, Izmir Bozyaka Education and Research Hospital Ministry of Health, 9207 sokak No:4 Daire:2 Maliyeciler sitesi, Karabağlar Izmir, Turkey.

Department of Surgery, Ege University Faculty of Medicine, Izmir, Turkey.

出版信息

Indian J Surg. 2013 Apr;75(2):106-10. doi: 10.1007/s12262-012-0423-x. Epub 2012 Mar 15.

Abstract

Superior mesenteric artery syndrome is a rare but well-known clinical entity characterized by compression of the third or transverse portion of the duodenum against the aorta by the superior mesenteric artery, resulting in chronic, intermittent, or acute, complete or partial, duodenal obstruction. The treatment for this arteriomesenteric compression includes conservative measures and surgical intervention. The aim of the study was to evaluate our surgical management and outcomes of the patients with superior mesenteric artery syndrome. The cases with superior mesenteric artery syndrome admitted between January 2000 and January 2010 were retrospectively investigated from the patients' records. All six patients had a history of chronic abdominal pain, nausea, postprandial early satiety, vomiting, and weight loss. Diagnostic methods included barium esophagogastroduodenography, upper gastrointestinal endoscopy, and computed tomography. Medical management was the first step of treatment in all cases before surgery. Of those, four underwent Roux-en-Y duodenojejunostomy and two underwent gastroenterostomy. Postoperative periods were uneventful and mean duration of hospitalization after the operations was 7 days. Conservative initial treatment is usually followed by surgical intervention for the main problem that is the narrowing of the aortomesenteric angle in patients with superior mesenteric artery syndrome. This syndrome should be considered in the differential diagnosis in patients with chronic upper abdominal pain. Duodenojejunostomy is the most frequently used procedure with a high success rate.

摘要

肠系膜上动脉综合征是一种罕见但广为人知的临床病症,其特征为肠系膜上动脉将十二指肠第三部或横部压向主动脉,导致慢性、间歇性或急性的完全或部分十二指肠梗阻。这种动脉肠系膜压迫的治疗方法包括保守措施和手术干预。本研究的目的是评估我们对肠系膜上动脉综合征患者的手术治疗及疗效。对2000年1月至2010年1月期间收治的肠系膜上动脉综合征病例进行回顾性研究,查阅患者病历。所有6例患者均有慢性腹痛、恶心、餐后早饱、呕吐及体重减轻病史。诊断方法包括食管胃十二指肠钡餐造影、上消化道内镜检查及计算机断层扫描。在所有病例中,术前内科治疗是第一步。其中4例行Roux-en-Y十二指肠空肠吻合术,2例行胃肠吻合术。术后恢复顺利,术后平均住院时间为7天。对于肠系膜上动脉综合征患者,保守的初始治疗通常之后会针对主要问题即主动脉肠系膜角变窄进行手术干预。对于慢性上腹痛患者,鉴别诊断时应考虑到这种综合征。十二指肠空肠吻合术是最常用的手术方法,成功率较高。

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