肠系膜上动脉压迫综合征的诊断及术式选择评价  

Evaluation of Diagnosis and Operative Modality for Superior Mesenteric Artery Compressing Syndrome

作　　者：陈历恒 蒋晓忠[1] 杜一平[1] 朱勇[1] 龚光[1] 杨健[1] 

机构地区：[1]四川省宜宾市第二人民医院普外科,宜宾644000

出　　处：《中国普外基础与临床杂志》2008年第7期518-521,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的对肠系膜上动脉压迫综合征(superior mesenteric artery compressing syndrome,SMACS)的诊断及术式选择进行评价。方法对我院1999年1月至2006年12月期间收治的38例SMACS患者的临床资料进行回顾性分析。结果本组病例均行X线钡餐检查,有32例呈典型的十二指肠水平段与升段交界处纵行受压迫征象(笔杆征),21例钡剂在胃和十二指肠内形成明显的反复交流的"钟摆样"运动。行非手术治疗9例,手术治疗29例。其中手术包括Treitz韧带切断松解术4例,单纯胃空肠吻合术2例,Treitz韧带松解加十二指肠空肠Roux-en-Y吻合术7例,Treitz韧带松解加十二指肠空肠侧侧吻合术10例,胃大部切除、胃空肠吻合术(BillrothⅡ式)4例及肠系膜上血管前十二指肠空肠吻合术2例。全部病例均治愈出院。结论SMACS的诊断除应具有上腹胀痛、呕吐等典型症状外,主要的确诊手段为X线钡餐造影。治疗上首先采用保守治疗,无效者再行手术治疗。应正确判断致病因素,选择合适的手术方式,才能获得满意效果。Objective To evaluate the diagnosis and operative modality for superior mesenteric artery compressing syndrome （SMACS）. Methods The clinical data of 38 cases with SMACS from January 1999 to December 2006 in this hospital was analyzed retrospectively. Results All patients underwent barium meal examination and the diagnosis was easy to obtained according to clinical symptom and barium study. Among the 38 cases of SMACS, 9 cases underwent conservative treatment and 29 cases underwent surgical treatment. The operative modalities for these patients included lysis and downward movement of the Treitz ligament and extensive mobilization of the duodenum in 4 cases, gastrojejunal anastomosis in 2 cases, lysis of the Treitz ligament and Roux-en-Y duodenojejunostomy in 7 cases, lysis of the Treitz ligament and side to side duodenojejunostomy in 10 cases, Billroth Ⅱ gastrectomy in 4 cases, and anterior duodenojejunostomy in 2 cases. All patients were discharged from hospital as cured. Conclusion The diagnosis of SMACS should mainly depend on barium meal examination except for the typical clinical manifestations such as epigastric distending pain and vomiting. Conservative treatment should be chosen primarily before surgical decision. Correct diagnosis and appropriate operative modality for SMACS will lead to satisfactory outcomes.

关 键 词：肠系膜上动脉压迫综合征 诊断 手术治疗 

分 类 号：R657.2[医药卫生—外科学]