儿童肠系膜上动脉压迫综合征26例临床分析

Clinical analysis of superior mesenteric artery syndrome in children

目的探讨儿童肠系膜上动脉压迫综合征(superior mesenteric artery syndrome,SMAS)的临床诊断和治疗方法。方法结合文献复习对河南省人民医院小儿外科2013-03—2020-03间收治的26例SMAS患儿的临床资料进行回顾性分析。重点分析诊治方法和效果。结果26例患儿中,男15例,女11例;年龄6~14岁,病程3个月~6 a。以反复性腹痛、腹胀、恶心、呕吐为主要临床表现,病程长者常伴有消瘦、贫血等营养不良表现。经1~5 a随访,保守治疗4例,包括禁食、胃肠减压、应用解痉或胃动力药、纠正水电解质代谢紊乱、肠外营养支持、少食多餐,以及餐后改变体位等措施,2例痊愈,2例复发。手术治疗24例(含保守治疗无效的2例患儿),方法包括单纯Treitz韧带松解术(5例)、胃空肠吻合术(4例)、Treitz韧带松解+十二指肠-空肠侧侧吻合术(15例)。单纯Treitz韧带松解术后患儿3例复发,给予保守治疗,疗效欠佳,再次加做十二指肠-空肠侧侧吻合术后痊愈。胃空肠吻合术后4例患儿均再次出现腹痛、呕吐症状,给予保守治疗后痊愈。Treitz松解+十二指肠-空肠侧侧吻合术后2例复发,给予保守治疗后痊愈。各手术组病程、随访时间差异无统计学意义(P>0.05),复发率差异有统计学意义(P<0.05)。结论本病临床症状无特异性,诊断主要靠彩色多普勒超声检查、CT血管造影及上消化道造影。保守治疗及单纯Treitz韧带松解术仅对部分患儿有效。胃空肠吻合术后患儿近期效果欠佳,症状容易复发。Treitz韧带松解+十二指肠-空肠侧侧吻合术疗效确切,应作为首选术式。

Objective To explore the clinical diagnosis and treatment of superior mesenteric artery syndrome(SMAS)in children.Methods The clinical data of 26 children with SMAS admitted to the Department of Pediatric Surgery of Henan Provincial People’s Hospital from March 2013 to March 2020 were retrospectively analyzed,including 15 males and 11 females,aged 6~14 years,and the median age was 7.4 years.The disease duration ranged from 3 months to 6 years.The main clinical symptoms are recurrent abdominal pain,bloating,nausea,and vomiting.Patients with a long disease course often have malnutrition such as weight loss and anemia.Results All patiens were followed up for 1~5 years.In all patients,4 cases were treated conservatively,including fasting,gastrointestinal decompression,application of antispasmodic or prokinetic drugs,correction of water and electrolyte disorders,intravenous nutritional support,eating less frequent meals,and changing posture after meals.2 cases recovered and 2 cases relapsed.Surgical treatment was performed in 24 cases(including 2 patients who failed in conservative treatment).The surgical procedures included simple lysis of Treitz ligament(5 cases),gastrojejunostomy(4 cases),lysis of Treitz ligament and duodenum-jejunum lateral anastomosis(15 cases).3 relapsed cases after simple lysis of Treitz ligament had been poorly treated with multiple conservative treatment,and recovered again after duodenum-jejunum lateral anastomosis;4 cases treated with gastrojejunostomy,suffered from abdominal pain and vomiting again and recovered after conservative treatment.2 cases who underwent lysis of Treitz ligament+duodenum-jejunum lateral anastomosis relapsed and recovered after conservative treatment.Conclusion The clinical symptoms of SMAS are non-specific.The diagnosis is mainly based on color Doppler ultrasound,CT angiography and upper gastrointestinal contrast.Conservative treatment and simple lysis of Treitz ligament are only effective for some children;Short-term effect of gastrojejunostomy in children is not good,and it is prone to relapse.The effect of lysis of Treitz ligament+duodenum-jejunum lateral anastomosis is definite,and its application in the clinic is worth promoting.