中弓韧带压迫综合征外科手术治疗进展

Latest Progresses in Surgical Treatment of Median Arcuate Ligament Syndrome

中弓韧带压迫综合征为正中弓状韧带压迫腹腔干动脉导致的一种罕见疾病。对于症状严重且影像学检查明确的患者,必须采用手术治疗。正中弓状韧带松解术是手术治疗的基石。多数情况下,术后即刻可恢复腹腔干的血运。可选方式有开放式手术、腹腔镜手术或者机器人协助手术。其中,腹腔镜手术因其创伤小、恢复快的优势而成为首选方案。同时,辅助腹腔神经丛切除术可减少患者的不适感。若术后腹腔干动脉持续狭窄,可进一步行血运重建术,如腔内治疗或动脉搭桥手术。腔内治疗创伤更小,而动脉搭桥手术的再狭窄率更低。本文将梳理总结中弓韧带压迫综合征的外科治疗的共识以及最新进展,希望有助于为本病的外科治疗提供思路。

Median arcuate ligament syndrome(MALS)is compression of the celiac trunk by the median arcuate ligament.Median arcuate ligament release is the corner stone for the surgical treatment of MALS.Open surgery,laparoscopic surgery,and robot-assisted surgery have been developed,among which laparoscopic surgery has been proposed as the preferred approach in view of its minimal trauma and short hospital stay.Auxiliary celiac plexus neurolysis could further alleviate the patient’s discomfort.Moreover,vascular reconstitution is of vital importance in the case of persistent stenosis in the celiac artery despite of median arcuate ligament decompression.Vascular reconstruction has satisfactory long-term patency rate,while endovascular treatment is less invasive.This article aims to summarize the consensuses and advances and shed light on the surgical treatment of MALS.