Cordoba A, Gordillo O
Int Surg. 1979 May-Jul;64(4):67-9.
A case of acute mesenteric ischemia and massive intestinal infarction secondary to bilateral lumbar sympathectomy and without any other apparent precipitating factors is presented. Its characteristics and findings significantly agree with those described as part of the mesenteric arterial steal syndrome. Although this syndrome was originally described as secondary to surgical revascularization of the lower extremities, experimental studies have shown that lumbar sympathectomy, by means of reducing the peripheral vascular resistance in the lower extremities, similarly causes intense hemodynamic alteration of the mesenteric circulation due to the sudeen redistribution of blood flow to the lower limbs at the expense of the mesenteric flow. When marginally compensated occlusive mesenteric arterial disease exists prior to surgery, the sudden fall in the arterial pressure gradients in this vessel can precipitate the occlusion of these arteries, resulting in mesenteric ischemia and intestinal infarction. It has also been suggested that an intense vasospamodic neurogenic reflex in the mesenteric arteries is an important factor in the pathogenesis of this syndrome.
本文报告一例急性肠系膜缺血和大量肠梗死病例，该病例继发于双侧腰交感神经切除术，且无任何其他明显的诱发因素。其特征和发现与作为肠系膜动脉盗血综合征一部分所描述的情况显著相符。尽管该综合征最初被描述为下肢手术血管重建的继发症，但实验研究表明，腰交感神经切除术通过降低下肢外周血管阻力，同样会因血流突然重新分配至下肢而牺牲肠系膜血流，从而导致肠系膜循环发生强烈的血流动力学改变。当术前存在边缘性代偿性闭塞性肠系膜动脉疾病时，该血管动脉压梯度的突然下降可促使这些动脉发生闭塞，导致肠系膜缺血和肠梗死。也有人提出，肠系膜动脉强烈的血管痉挛性神经反射是该综合征发病机制中的一个重要因素。
