摘要
目的：探讨儿童肠系膜上动脉压迫综合征（ superior mesenteric artery syndrome ，SMAS）的临床特征、诊断与腹腔镜治疗方法。方法2006年7月～2012年7月，对8例保守治疗无效的SMAS行腹腔镜手术，包括单纯Treitz韧带松解术7例，Treitz韧带松解联合十二指肠空肠侧侧吻合术1例（术中粘连严重，单纯Treitz韧带松解术不充分）。结果8例均腹腔镜下顺利完成手术，单纯Treitz韧带松解术7例手术时间45～80 min，Treitz韧带松解联合十二指肠空肠侧侧吻合术1例100 min。无术中并发症，术后3～5 d开始饮食。术后所有患儿随访6～24个月，平均8个月。1例单纯Treitz韧带松解术后症状无改善，术后3个月行腹腔镜十二指肠空肠侧侧吻合术。2例行肠吻合者无吻合口漏、狭窄及梗阻，饮食正常，生长发育良好，6例单纯Treitz韧带松解术后恢复好，饮食正常。结论 B超、CT和X线钡餐检查是诊断儿童SMAS的重要方法。腹腔镜下单纯Treitz韧带松解或Treitz韧带松解联合十二指肠空肠侧侧吻合术是安全、简单、有效的治疗方法。
Objective To investigate the clinical characteristics , diagnostic methods , and laparoscopic treatment of superior mesenteric artery syndrome （SMAS） in children. Methods From July 2006 to July 2012, laparoscopic procedures were performed in 8 patients with SMAS , whose disease did not respond to conservative therapy .Laparoscopic lysis of the Treitz ligament was performed in 7 cases, and laparoscopic lysis of the Treitz ligament combined with side-to-side duodenojejunostomy was performed in 1 case. Results All the patients underwent operation successfully .The operation time of simple laparoscopic lysis was 45-80 min, and of laparoscopic lysis with side-to-side duodenojejunostomy was 100 min.All the patients were followed up for 6 -24 months （mean, 8 months）.In 1 case of simple laparoscopic lysis of the Treitz ligament , symptoms were not relieved postoperatively , and another laparoscopic side-to-side duodenojejunostomy was conducted 3 months later.There were no anastomotic leakage , stenosis, or obstruction postoperatively .The patients had normal diet and growth and development during the followed -up visits. Conclusions The diagnosis of superior mesenteric artery syndrome should depend on ultrasonography , CT and barium meal examination . Laparoscopic lysis of the Treitz ligament , with or without side-to-side duodenojejunostomy , can be used as the first choice for the treatment of superior mesenteric artery syndrome in children .
出处
《中国微创外科杂志》
CSCD
2014年第7期641-643,共3页
Chinese Journal of Minimally Invasive Surgery
