Téoule Patrick, Tombers Katharina, Rahbari Mohammad, Sandra-Petrescu Flavius, Keese Michael, Rahbari Nuh N, Reißfelder Christoph, Rückert Felix
Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
Chirurgische Klinik, European Center for AngioScience (ECAS) Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.
Chirurg. 2022 Feb;93(2):173-181. doi: 10.1007/s00104-021-01427-4. Epub 2021 Jun 8.
The superior mesenteric artery (SMA) is exposed and dissected during pancreatic resections (PR) and mesenteric vascular surgery (MVS). The resulting damage of the surrounding extrinsic and intrinsic vegetative nerve plexus can lead to a temporary or treatment refractory diarrhea.
This study aimed to provide an overview of the current status of SMA revascularization and dissection-associated diarrhea (SMARD syndrome) in Germany.
After a selective literature search (SLS) on the frequency of newly developed postoperative diarrhea after PR and MVS, an online survey was initiated.
The SLS (n = 4) confirmed that newly developed postoperative diarrhea is a frequent complication after preparation for revascularization (RV) or dissection (DIS) of the SMA (incidence approximately 62%). Treatment refractive courses were relatively uncommon with 14%. Out of 159 centers 54 took part in the survey and 63% stated that they carried out an SMA RV/DIS during PR or MVS. The average PR per center was 47 in 2018 and 49 in 2019. The average MVS was 5 per center in both years and on average 3 patients suffered from SMARD syndrome.
This survey recorded the current status of the SMARD syndrome in Germany for the first time. So far there are no recommendations for the treatment of such a diarrhea. The results show that initially a symptomatic treatment should be carried out. Due to the complexity of the pathophysiology, causal treatment approaches have not yet been developed.
在胰腺切除术（PR）和肠系膜血管手术（MVS）过程中，需要暴露并解剖肠系膜上动脉（SMA）。由此导致的周围外在和内在植物神经丛损伤可引发暂时性或治疗难治性腹泻。
本研究旨在概述德国SMA血运重建及解剖相关腹泻（SMARD综合征）的现状。
在对PR和MVS术后新发性腹泻的发生率进行选择性文献检索（SLS）后，开展了一项在线调查。
SLS（n = 4）证实，SMA血运重建（RV）或解剖（DIS）术后新发性腹泻是一种常见并发症（发生率约62%）。治疗难治性病程相对少见，为14%。在159个中心中，54个参与了调查，63%表示他们在PR或MVS期间进行了SMA RV/DIS。2018年每个中心的平均PR为47例，2019年为49例。两年中每个中心的平均MVS均为5例，平均有3例患者患有SMARD综合征。
本次调查首次记录了德国SMARD综合征的现状。目前尚无针对此类腹泻的治疗建议。结果表明，最初应进行对症治疗。由于病理生理学的复杂性，尚未开发出病因治疗方法。
