Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, OH.
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, OH.
Surgery. 2023 Sep;174(3):473-479. doi: 10.1016/j.surg.2023.04.014. Epub 2023 Jun 8.
Idiopathic myointimal hyperplasia of the mesenteric veins is an extremely rare non-thrombotic mesenteric veno-occlusive disease. The management of idiopathic myointimal hyperplasia of the mesenteric veins is not well-established, and although surgery is the mainstay of treatment, the optimal operation remains unclear. Therefore, we aimed to perform a systematic review to assess the various surgical procedures and associated outcomes for patients with idiopathic myointimal hyperplasia of the mesenteric veins.
A systematic search for articles published from 1946 to April 2022 in MEDLINE, EMBASE, Cinahl, Scopus, Web of Science, and Cochrane Library databases is reported. In addition, we report 4 cases of idiopathic myointimal hyperplasia of the mesenteric veins managed at our institution until March 2023.
A total of 53 studies and 88 patients with idiopathic myointimal hyperplasia of the mesenteric veins were included. Most (82%) were male patients, with a mean age of 56.6 years old. The majority (99%) of patients required surgery. Most reports described the involvement of the rectum and sigmoid colon (81%). The most common surgical procedures were Hartmann's procedure (24%) and segmental colectomy (19%); completion proctectomy with ileal pouch-anal anastomosis was performed in 3 (3.4%) cases. In 6 (6.8%) cases, idiopathic myointimal hyperplasia of the mesenteric veins was suspected preoperatively and managed with elective surgery. Four (4.5%) complications were reported. Nearly all (99%) patients achieved remission with surgical intervention.
Idiopathic myointimal hyperplasia of the mesenteric veins is a rare pathologic entity infrequently suspected preoperatively and typically diagnosed after surgical resection. Surgical resection with Hartmann's procedure or segmental colectomy was most commonly performed, with completion proctectomy and ileal pouch-anal anastomosis reserved for cases of extensive rectal involvement. Surgical resection was safe and effective, with a low risk of complications and recurrence. Surgical decision-making should be based on the extent of the disease at the time of presentation.
肠系膜静脉特发性内膜增生是一种极其罕见的非血栓性肠系膜静脉闭塞性疾病。特发性肠系膜静脉内膜增生的治疗方法尚未确立，尽管手术是主要的治疗方法，但最佳手术方法仍不清楚。因此，我们旨在进行系统评价，以评估特发性肠系膜静脉内膜增生患者的各种手术程序和相关结果。
报告了从 1946 年至 2022 年 4 月在 MEDLINE、EMBASE、Cinahl、Scopus、Web of Science 和 Cochrane Library 数据库中发表的文章的系统搜索。此外，我们还报告了截至 2023 年 3 月在我们机构治疗的 4 例特发性肠系膜静脉内膜增生病例。
共纳入 53 项研究和 88 例特发性肠系膜静脉内膜增生患者。大多数（82%）为男性患者，平均年龄为 56.6 岁。大多数（99%）患者需要手术。大多数报告描述了直肠和乙状结肠受累（81%）。最常见的手术程序是 Hartmann 手术（24%）和节段性结肠切除术（19%）；完成直肠切除术和回肠袋肛门吻合术的 3 例（3.4%）。术前怀疑 6 例（6.8%）为特发性肠系膜静脉内膜增生，行择期手术治疗。报告了 4 例（4.5%）并发症。几乎所有（99%）患者通过手术干预获得缓解。
特发性肠系膜静脉内膜增生是一种罕见的病理实体，术前很少怀疑，通常在手术后诊断。最常进行的手术切除方法是 Hartmann 手术或节段性结肠切除术，对于广泛直肠受累的病例保留完成直肠切除术和回肠袋肛门吻合术。手术切除安全有效，并发症和复发风险低。手术决策应基于发病时疾病的严重程度。
