Massoud W Z
Department of Surgery, University of Cairo, Egypt.
Int Surg. 1995 Oct-Dec;80(4):322-7.
Superior mesenteric artery syndrome (SMAS) is a rare clinical condition that should be considered in patients with long-standing abdominal complaints where endoscopic and conventional roentgenographical findings are often negative. It has been claimed that SMAS is caused by intermittent obstruction of the horizontal portion of the duodenum between the superior mesenteric artery and the spine and the aorta. The main target of this presentation is to present our experience in the laparoscopic management of 4 cases of documented SMAS after failure of medical treatment. The laparoscopic severing of the ligament of Treitz is a feasible and safe technique. It could bring about total relief of symptoms in three out of the four patients. The operative time rapidly decreased with the acquaintance of the field. The visualization (exposure) is quite satisfactory. the technique offers added precision and accuracy to the dissection manoeuvres. Recovery was uneventful and rapid with minimal needs for postoperative analgesia. We recommend the use of mini-endoshear (pediatric). Phases of dissection from the mesocolon and retro-pancreatically are presented. We stress the finding of the drainage of the inferior mesenteric vein into the superior mesenteric vein instead of the splenic vein. This could put the inferior mesenteric vein (looking as a fibrous band) in jeopardy. Also it reduces the area of access to the retropancreatic dissection. We raise the possibility of an etiological role of this anatomical variation to the duodenal compression and call upon the study of such a possibility. The importance to attain the proper retropancreatic space has been shown by the possibility of dissecting between the uncinate process and the rest of the pancreas. The psychological impact of a minimal invasive approach together with symptoms relief was quite rewarding.
肠系膜上动脉综合征（SMAS）是一种罕见的临床病症，对于有长期腹部不适且内镜和传统X线检查结果常为阴性的患者应考虑此病。据称，SMAS是由肠系膜上动脉与脊柱和主动脉之间十二指肠水平部的间歇性梗阻所致。本报告的主要目的是介绍我们对4例经药物治疗失败的确诊SMAS患者进行腹腔镜治疗的经验。腹腔镜下切断Treitz韧带是一种可行且安全的技术。它能使4例患者中的3例症状完全缓解。随着对该领域的熟悉，手术时间迅速缩短。可视化（暴露）效果相当令人满意。该技术为解剖操作提供了更高的精确性和准确性。恢复过程顺利且迅速，术后镇痛需求 minimal。我们推荐使用微型内镜剪（儿科用）。介绍了从中结肠和胰后进行解剖的阶段。我们强调发现肠系膜下静脉引流至肠系膜上静脉而非脾静脉。这可能使肠系膜下静脉（看起来像一条纤维带）处于危险之中。此外，它还减少了胰后解剖的操作区域。我们提出这种解剖变异对十二指肠压迫可能具有病因学作用的可能性，并呼吁对此可能性进行研究。通过在钩突与胰腺其余部分之间进行解剖的可能性，已表明获得合适的胰后间隙的重要性。微创方法带来的心理影响以及症状缓解相当令人欣慰。
