57例肠系膜上动脉综合征诊治分析

Diagnosis and Treatment of Superior Mesenteric Artery Syndrome:Analysis of 57 Cases

背景:近年来,肠系膜上动脉综合征(SMAS)的检出率呈上升趋势,但仍存在较高的误诊、漏诊率。目的:探讨SMAS的临床诊治特点。方法:收集1993年1月～2011年8月暨南大学医学院附属广州红十字会医院和暨南大学附属第一医院57例确诊SMAS患者的病例资料,对其临床表现、诊断情况以及治疗和预后进行回顾性分析。结果:本组SMAS患者的临床症状以腹痛、腹胀最为多见(33例,57.9%),其次为恶心、呕吐(19例,33.3%),其他临床表现包括嗳气、反酸、纳差、呃逆、消瘦等。55例接受上消化道钡餐检查者均有阳性发现并确诊为SMAS,另2例患者分别经CT检查和手术探查确诊。14例患者确诊前有误诊、漏诊史,发生率为24.6%。55例患者接受内科保守治疗,1例接受中医药治疗,1例接受手术治疗,均治愈出院。结论:对于长期腹痛、腹胀、恶心、呕吐,胃镜、结肠镜检查未能明确病因且按常见消化道疾病治疗效果欠佳者,应考虑SMAS的可能。根据典型临床表现和上消化道钡餐检查结果可早期明确诊断,减少误诊、漏诊。

Background： The detection rate of superior mesenteric artery syndrome （SMAS） is increasing in recent years, however, there are still high rates of misdiagnosis and missed diagnosis for this disease. Aims： To investigate the clinical characteristics for diagnosis and treatment of SMAS. Methods ： The clinical data of 57 patients with confirmed SMAS at the Guangzhou Red Cross Hospital Affiliated to Jinan University School of Medicine and the First Affiliated Hospital of Jinan University from Jan. 1993 to Aug. 2011 were collected. The manifestations, diagnosis, treatment and prognosis of these patients were analyzed retrospectively. Results： The most common symptoms of SMAS patients enrolled in this study were abdominal pain and distension （33 cases, 57.9% ）, and the next were nausea and vomiting （ 19 cases, 33.3% ）. Other manifestations included belching, acid regurgitation, poor appetite, hiccups and weight loss, etc. Fifty-five patients were diagnosed by upper gastrointestinal barium meal examination; one case was diagnosed by CT and one by surgical procedure. Fourteen patients （24. 6% ） had a history of misdiagnosis or missed diagnosis before the final definite diagnosis. Fifty-five patients received medical treatment, one received traditional Chinese medicine therapy and one with surgical procedure. All patients were cured and discharged. Conclusions： When patients complained of long-term abdominal pain and distension and nausea and vomiting, especially those who failed to be diagnosed by gastroscopy and colonoscopy and did not respond to conventional therapy of gastrointestinal diseases, SMAS should be considered as the possible etiological factor. Early diagnosis might be achieved by typical manifestations combined with upper gastrointestinal barium meal examination, thereby avoiding misdiagnosis and missed diagnosis.