Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands; Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, the Netherlands.
Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands; Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, the Netherlands.
Eur J Vasc Endovasc Surg. 2022 Dec;64(6):720-732. doi: 10.1016/j.ejvs.2022.08.033. Epub 2022 Sep 6.
Since the first description of the median arcuate ligament syndrome (MALS), the existence for the syndrome and the efficacy of treatment for it have been questioned.
A systematic review conforming to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was conducted, with a broader view on treatment for MALS including any kind of coeliac artery release, coeliac plexus resection, and coeliac plexus blockage, irrespective of age. Online databases were used to identify papers published between 1963 and July 2021. The inclusion criteria were abdominal symptoms, proof of MALS on imaging, and articles reporting at least three patients. Primary outcomes were symptom relief and quality of life (QoL).
Thirty-eight studies describing 880 adult patients and six studies describing 195 paediatric patients were included. The majority of the adult studies reported symptom relief of more than 70% from three to 228 months after treatment. Two adult studies showed an improved QoL after treatment. Half of the paediatric studies reported symptom relief of more than 70% from six to 62 months after laparoscopic coeliac artery release, and four studies reported an improved QoL. Thirty-five (92%) adult studies and five (83%) paediatric studies scored a high or unclear risk of bias for the majority of the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) items. The meaning of coeliac plexus resection or blockage could not be substantiated.
This systematic review suggests a sustainable symptom relief of more than 70% after treatment for MALS in the majority of adult and paediatric studies; however, owing to the heterogeneity of the inclusion criteria and outcome parameters, the risk of bias was high and a formal meta-analysis could not be performed. To improve care for patients with MALS the next steps would be to deal with reporting standards, outcome definitions, and consensus descriptions of the intervention(s), after which an appropriate randomised controlled trial should be performed.
自从首例正中弓状韧带综合征（MALS）的描述以来，该综合征的存在及其治疗效果一直受到质疑。
按照 PRISMA（系统评价和荟萃分析的首选报告项目）声明进行了系统评价，更广泛地看待 MALS 的治疗方法，包括任何类型的腹腔动脉松解、腹腔丛切除术和腹腔丛阻滞，无论年龄大小。使用在线数据库来确定 1963 年至 2021 年 7 月期间发表的论文。纳入标准为腹部症状、影像学证实 MALS 以及至少报告 3 例患者的文章。主要结局指标为症状缓解和生活质量（QoL）。
纳入了 38 项描述 880 例成年患者的研究和 6 项描述 195 例儿科患者的研究。大多数成年患者的研究报告，在治疗后 3 至 228 个月，症状缓解率超过 70%。2 项成年患者研究报告，治疗后生活质量得到改善。半数儿科患者的研究报告，在腹腔镜腹腔动脉松解后 6 至 62 个月，症状缓解率超过 70%，4 项研究报告生活质量得到改善。35 项（92%）成年患者的研究和 5 项（83%）儿科患者的研究在大多数 Quality Assessment of Diagnostic Accuracy Studies 2（QUADAS-2）项目中，其偏倚风险得分为高或不清楚。腹腔丛切除术或阻滞的意义无法得到证实。
这项系统评价表明，在大多数成年和儿科患者的研究中，MALS 治疗后症状缓解率超过 70%；然而，由于纳入标准和结局参数的异质性，偏倚风险较高，无法进行正式的荟萃分析。为了改善 MALS 患者的护理，下一步将是处理报告标准、结局定义以及干预措施的共识描述，之后应进行适当的随机对照试验。
