Ho Kelvin Kam Fai, Walker Philip, Smithers B Mark, Foster Wallace, Nathanson Leslie, O'Rourke Nicholas, Shaw Ian, McGahan Timothy
University of Queensland School of Medicine, Queensland, Australia; The Prince Charles Hospital, Queensland, Australia.
University of Queensland School of Medicine, Queensland, Australia; Discipline of Surgery, University of Queensland, Queensland, Australia; Centre for Clinical Research, University of Queensland, Queensland, Australia; Royal Brisbane and Women's Hospital, Queensland, Australia.
J Vasc Surg. 2017 Jun;65(6):1745-1752. doi: 10.1016/j.jvs.2016.11.040. Epub 2017 Feb 8.
Median arcuate ligament syndrome (MALS) is a condition characterized by chronic abdominal symptoms associated with median arcuate ligament compression of the celiac artery. The selection of patients is difficult in the management of MALS. This study aimed to identify factors that predict outcomes of surgical and nonoperative treatment in these patients.
Patients referred with a possible diagnosis of MALS between 1998 and 2013 were identified retrospectively. Only patients with chronic symptoms and radiologically confirmed celiac artery compression were included. The clinical features, investigations, and management were documented. Outcome was assessed using the Visick score, Gastrointestinal Symptom Rating Scale, and 12-Item Short Form Health Survey by telephone interview and review of medical records.
There were 67 patients, 43 (64%) treated surgically and 24 (36%) managed without surgery, with a median follow-up of 25 months and 24 months, respectively. After surgical treatment, 16 (37%) were asymptomatic, 24 (56%) were partially improved, 3 (7%) had no changes in symptoms, and none had worsening of symptoms. Postexertional pain predicted improvement after surgery (P = .022). Vomiting (P = .046) and unprovoked pain (P = .006) were predictors of poor surgical outcome. After nonoperative management, 1 (4%) was asymptomatic, 7 (29%) were partially improved, 12 (50%) had no changes in symptoms, and 4 (17%) had worsening of symptoms. No outcome predictors of nonoperative treatment were identified.
MALS was more likely to respond to decompression if patients had postexertional pain. Patients who presented with vomiting and unprovoked pain were unlikely to respond to surgery. In contrast with previous studies, postprandial pain was not found to be predictive of outcome.
正中弓状韧带综合征（MALS）是一种以慢性腹部症状为特征的疾病，与腹腔干受正中弓状韧带压迫有关。在MALS的治疗中，患者的选择较为困难。本研究旨在确定预测这些患者手术和非手术治疗结果的因素。
回顾性确定1998年至2013年间因可能诊断为MALS而转诊的患者。仅纳入有慢性症状且经放射学证实腹腔干受压的患者。记录其临床特征、检查及治疗情况。通过电话访谈和查阅病历，使用Visick评分、胃肠道症状评定量表和简明健康调查12项量表评估结果。
共67例患者，43例（64%）接受手术治疗，24例（36%）未接受手术治疗，中位随访时间分别为25个月和24个月。手术治疗后，16例（37%）无症状，24例（56%）部分改善，3例（7%）症状无变化，无患者症状恶化。运动后疼痛预示手术后改善（P = 0.022）。呕吐（P = 0.046）和自发痛（P = 0.006）是手术效果不佳的预测因素。非手术治疗后，1例（4%）无症状，7例（29%）部分改善，12例（50%）症状无变化，4例（17%）症状恶化。未发现非手术治疗的结果预测因素。
如果患者有运动后疼痛，MALS更可能对减压治疗有反应。出现呕吐和自发痛的患者不太可能对手术有反应。与先前研究不同，未发现餐后疼痛可预测治疗结果。
