MacFarlane S D, Beebe H G
Section of Vascular Surgery, Virginia Mason Clinic, Virginia Mason Medical Center, Seattle, WA.
J Cardiovasc Surg (Torino). 1989 Mar-Apr;30(2):178-84.
Analysis of surgical treatment for chronic mesenteric arterial occlusive lesions in 45 patients between 1964 and 1986 has shown an evolution in diagnostic criteria, indications for operation, and surgical technique. Prior to 1976, a variety of surgical procedures (diaphragmatic crus release, arterial dilation, patch angioplasty, reimplantation, endarterectomy) were employed in treatment of patients with a wide range of symptoms and variation in number of mesenteric vessels involved. Since 1976, we have selected patients with "typical" symptoms (postprandial epigastric pain, fear of eating, weight loss) and 2 or 3 vessel disease, and have avoided surgery for celiac crus lesions. Typical symptoms were seldom present in isolated celiac artery crus compression, 4 of 15 pts (23%), but were often present with 2 or 3 vessel disease, 17 of 28 pts (61%, p = 0.03). Satisfactory resolution of pain was achieved in 18 of 24 pts with 2 or 3 vessel disease. We conclude that presence of "typical" symptoms and angiographic findings of 2 or 3 vessel disease are prerequisites for effective surgical treatment. Bypass graft is our surgical technique of choice, but the extent of arterial reconstruction required to relieve symptoms remains undefined.
对1964年至1986年间45例慢性肠系膜动脉闭塞性病变患者的手术治疗分析表明，诊断标准、手术指征和手术技术都有所发展。1976年以前，针对症状范围广泛且肠系膜血管受累数量各异的患者，采用了多种手术方法（膈肌脚松解、动脉扩张、补片血管成形术、再植术、动脉内膜切除术）。自1976年以来，我们选择了有“典型”症状（餐后上腹部疼痛、惧食、体重减轻）且存在两到三支血管病变的患者，避免对腹腔干病变进行手术。典型症状在孤立性腹腔干压迫中很少出现，15例患者中有4例（23%），但在两到三支血管病变中经常出现，28例患者中有17例（61%，p = 0.03）。24例两到三支血管病变患者中有18例疼痛得到了满意缓解。我们得出结论，“典型”症状的存在以及两到三支血管病变的血管造影表现是有效手术治疗的前提条件。旁路移植术是我们首选的手术技术，但缓解症状所需的动脉重建范围仍不明确。
