Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Vasc Health Risk Manag. 2022 Mar 24;18:139-151. doi: 10.2147/VHRM.S350841. eCollection 2022.
The selection of patients with MALS for surgical treatment depends upon the reliability of the symptom interpretation and the diagnostic work-up. We aimed to follow up the results of the laparoscopic decompression of the patients with MALS.
In a single-center, 52 consecutive MALS patients were followed-up, prospectively, after transperitoneal laparoscopic decompression. MALS was diagnosed with a computed tomography angiography (CTA) verified stenosis, ≥50% of the celiac artery (CA), and with duplex ultrasound, a peak systolic velocity (PSV) ≥2.0 m/s. Postoperative, CTA, and duplex ultrasound were performed, and the patients were followed-up at 3, 6, 12 months, and yearly after that.
Mean age of the patients was 47 ±21 years, and 65% were females. The patients had a mean weight loss of 8.4 ±7.2 kg. Fifty-one patients had the laparoscopic operation with a mean operation time of 102 ± 28 minutes. Forty-seven patients (90%) achieved relief from the symptoms either completely (67%) or partially (23%) at 3-6 months of follow-up. Significant improvement in postoperative PSV was found compared to the preoperative values, p<0.001. Five patients (10%) with no immediate effect of the operation, but two of them became free from symptoms during the mean study follow-up of 2.4 ± 2 years. Five patients (10%) had operative complications, including one trocar injury to the liver, one pneumothorax, and three cases of bleeding from the branches of CA. Two patients died of cancer disease during the study period. Only two patients (4%) had symptoms relapse, both later treated successfully.
Laparoscopic transperitoneal decompression provides most of the patients a persistent relief from MALS symptoms.
选择 MALS 患者进行手术治疗取决于症状解释和诊断工作的可靠性。我们旨在跟踪腹腔镜减压治疗 MALS 患者的结果。
在单中心前瞻性研究中，对 52 例经腹腔腹腔镜减压的 MALS 患者进行了随访。MALS 的诊断依据是计算机断层血管造影（CTA）证实的狭窄，腹腔动脉（CA）≥50%，且双功超声显示收缩期峰值速度（PSV）≥2.0m/s。术后行 CTA 和双功超声检查，患者在术后 3、6、12 个月及此后每年进行随访。
患者的平均年龄为 47±21 岁，65%为女性。患者平均体重减轻 8.4±7.2kg。51 例患者行腹腔镜手术，平均手术时间为 102±28 分钟。47 例（90%）患者在术后 3-6 个月完全（67%）或部分（23%）缓解症状。与术前相比，术后 PSV 显著改善，p<0.001。5 例（10%）患者手术即刻无效果，但其中 2 例在平均 2.4±2 年的研究随访期间症状消失。5 例（10%）患者发生手术并发症，包括 1 例经皮肝穿刺损伤、1 例气胸和 3 例 CA 分支出血。2 例患者在研究期间死于癌症。仅 2 例（4%）患者出现症状复发，均经治疗成功。
经腹腔腹腔镜减压为大多数 MALS 患者提供了持久的症状缓解。
