儿童肠系膜上动脉压迫综合征5例腹腔镜治疗体会并文献复习  

Therapeutic laparoscopy for superior mesenteric artery syndrome in 5 children:treatment experience and lite-rature review

作　　者：陈浩 孙小刚[2] 李殿国[2] 陈维秀[2] Chen Hao;Sun Xiaogang;Li Dianguo;Chen Weixiu(Department of Pediatric Surgery,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou 362000,China;Department of Pediatric Surgery,the Second Hospital of Shandong University,Ji′nan 250033,China)

机构地区：[1]福建医科大学附属泉州第一医院小儿外科,泉州362000 [2]山东大学第二医院小儿外科,济南250033

出　　处：《中华实用儿科临床杂志》2022年第24期1903-1906,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨儿童肠系膜上动脉压迫综合征(SMAS)的临床特点和腹腔镜治疗方法。方法回顾性研究。2017年3月至2022年3月山东大学第二医院保守治疗无效的SMAS患儿5例均行腹腔镜下屈氏韧带松解+十二指肠下移术,结合万方及PubMed数据库进行分析。结果5例SMAS患儿中男3例,女2例,年龄(12.4±1.4)岁,术前体重指数为(15.2±0.8)kg/m^(2),以呕吐、腹痛及消瘦入院,发病时长平均(8.4±7.8)个月,均顺利行胃镜检查、腹腔下屈氏韧带松解及十二指肠下移术,无中转开放,手术时间为(66.0±10.7)min。术后1 d开始进食。1例术后4 d出现乳糜漏,经保守治疗11 d后治愈。1例术后10 d仍恶心,呕吐,予胸膝位后好转,未见其余短期并发症。术后中位住院时间7(6~22)d,术后中位随访时间21(9~56)个月,均恢复良好,体重增加,1例轻度复发症状,保守治疗后缓解。检索到15篇经屈氏韧带松解术治疗的SMAS文献,治愈率40%~100%,仅1组病例治愈率在75%以下。结论腹腔镜下屈氏韧带松解+十二指肠下移术治疗儿童SMAS有其安全、有效、简便及微创的优点,可作为多数患儿的首选术式。Objective To investigate the clinical characteristics and therapeutic laparoscopy treatment for superior mesenteric artery syndrome(SMAS)in children.Methods A retrospective study on 5 children with SMAS who failed to respond to the conservative treatment in the Second Hospital of Shandong University from March 2017 to March 2022 was carried out.All the patients underwent the laparoscopic lysis of the ligament of Treitz and duodenal lowering procedure.The clinical data were analyzed and literature retrieved from Wanfang and PubMed databases were reviewed.Results There were 3 boys and 2 girls in the 5 cases with SMAS.The average age was(12.4±1.4)years,and the preoperative body mass index was(15.2±0.8)kg/m^(2).The patients were admitted to the hospital with vomiting,abdominal pain and emaciation symptoms,and the duration of symptoms was(8.4±7.8)months.Gastroscopy,laparoscopic lysis of the ligament of Treitz and duodenal lowering procedure were performed successfully in all the patients,without conversions to open surgery.The average operation duration was(66.0±10.7)min.Food intake was allowed 1 day after surgery.Chylous fistula occurred 4 days after operation in one patient,whose symptom relieved after 11 days of conservative treatment.One patient still had nausea and vomiting symptoms 10 days after operation and was healed by knee-chest posture treatment.No other short-term complications were observed.The median postoperative duration of stay in the hospital was 7(6-22)days.The patients were followed up for 9-56(median:21)months.All of them recovered well and gained weight.One patient had mild recurrent symptoms,and was cured after conservative treatment.A total of 15 literature on the treatment of SMAS by laparoscopic lysis of the ligament of Treitz was retrieved,and the cure rate was 40%-100%.Only one group of these cases had a cure rate below 75%.Conclusions The laparoscopic lysis of the ligament of Treitz and duodenal lowering procedure is safe,effective,simple and minimally invasive treatment for children

关 键 词：肠系膜上动脉压迫综合征 屈氏韧带松解 腹腔镜 儿童 

分 类 号：R726.5[医药卫生—儿科]