BACKGROUND Median arcuate ligament syndrome(MALS)is a rare disease caused by compression of the celiac trunk artery by the median arcuate ligament(MAL).It can cause symptoms of postprandial abdominal pain,weight loss,...BACKGROUND Median arcuate ligament syndrome(MALS)is a rare disease caused by compression of the celiac trunk artery by the median arcuate ligament(MAL).It can cause symptoms of postprandial abdominal pain,weight loss,and nausea and vomiting.CASE SUMMARY A 55-year-old woman was admitted due to abdominal pain,nausea and vomiting.On admission,the patient presented with epigastric pain that worsened after eating,without signs of peritoneal irritation.Computed tomography angiography of the upper abdomen showed compression of the proximal segment of the abdominal trunk,local luminal stenosis with angular“fishhook”changes,which changed significantly during forceful inspiration and expiration;gallbladder stones;and multiple cysts in the liver.Abdominal duplex ultrasonography showed that peak systolic velocity was 352 cm/s.After diagnosis of MALS was confirmed,an arch ligament release procedure was performed.MALS has no specific symptoms and can be misdiagnosed as other abdominal diseases.Awareness of MALS should be improved to avoid misdiagnosis.The commonly used treatment option is MAL release and resection of the peripheral ganglion of the celiac trunk artery.CONCLUSION The diagnosis and treatment of MALS must be individualized,and MAL release is effective and provides immediate symptomatic relief.展开更多
背景感染性胰腺坏死临床多采用手术治疗.然而,术后残余组织的引流仍存在引流不充分,引流管易堵塞等问题.本研究拟采取胰周双腔引流管大容量灌洗并持续负压引流的方法,并与同期采用普通引流的患者相比较.目的探讨胰周双腔引流管大容量灌...背景感染性胰腺坏死临床多采用手术治疗.然而,术后残余组织的引流仍存在引流不充分,引流管易堵塞等问题.本研究拟采取胰周双腔引流管大容量灌洗并持续负压引流的方法,并与同期采用普通引流的患者相比较.目的探讨胰周双腔引流管大容量灌洗并持续负压引流用于感染性胰腺坏死(infected pancreatic necrosis,IPN)的临床疗效.方法回顾性分析铜川市人民医院肝胆胰脾外科2015-06/2019-06收治的57例行手术治疗的感染性胰腺坏死患者的临床资料.按照术后冲洗引流方式不同,分为双腔引流管组和普通引流管组.双腔引流管组患者术中放置胰周双腔引流管并在术后行大容量灌洗并持续负压引流;普通引流管组患者术中放置小网膜囊引流管并术后行常规冲洗和引流.观察并比较两组患者治疗效果及引流情况.结果两组在人口统计学数据、胰腺炎的病因和疾病严重程度、手术时间、术中失血量、重症护理时间方面无明显差异.两组术后持续器官衰竭逆转数(84.21%vs 56.25%,P=0.13),严重并发症发生率(16.67%vs 33.33%,P=0.14)无明显差异;总体死亡率为12.28%.尽管无显著的统计学差异(P=0.17),但普通引流管组患者死亡率更高.双腔引流管组APACHEⅡ评分减少幅度更大(8.03±2.13 vs 3.85±1.29,P<0.01),无再手术病例(0 vs 22.22%,P=0.008),住院时间更短,引流管更通畅,能够更早的拔除引流管(P<0.01).结论经双腔引流管大容量灌洗并持持续负压引流是IPN的有效引流方法,可有效治疗IPN.展开更多
文摘BACKGROUND Median arcuate ligament syndrome(MALS)is a rare disease caused by compression of the celiac trunk artery by the median arcuate ligament(MAL).It can cause symptoms of postprandial abdominal pain,weight loss,and nausea and vomiting.CASE SUMMARY A 55-year-old woman was admitted due to abdominal pain,nausea and vomiting.On admission,the patient presented with epigastric pain that worsened after eating,without signs of peritoneal irritation.Computed tomography angiography of the upper abdomen showed compression of the proximal segment of the abdominal trunk,local luminal stenosis with angular“fishhook”changes,which changed significantly during forceful inspiration and expiration;gallbladder stones;and multiple cysts in the liver.Abdominal duplex ultrasonography showed that peak systolic velocity was 352 cm/s.After diagnosis of MALS was confirmed,an arch ligament release procedure was performed.MALS has no specific symptoms and can be misdiagnosed as other abdominal diseases.Awareness of MALS should be improved to avoid misdiagnosis.The commonly used treatment option is MAL release and resection of the peripheral ganglion of the celiac trunk artery.CONCLUSION The diagnosis and treatment of MALS must be individualized,and MAL release is effective and provides immediate symptomatic relief.
文摘背景感染性胰腺坏死临床多采用手术治疗.然而,术后残余组织的引流仍存在引流不充分,引流管易堵塞等问题.本研究拟采取胰周双腔引流管大容量灌洗并持续负压引流的方法,并与同期采用普通引流的患者相比较.目的探讨胰周双腔引流管大容量灌洗并持续负压引流用于感染性胰腺坏死(infected pancreatic necrosis,IPN)的临床疗效.方法回顾性分析铜川市人民医院肝胆胰脾外科2015-06/2019-06收治的57例行手术治疗的感染性胰腺坏死患者的临床资料.按照术后冲洗引流方式不同,分为双腔引流管组和普通引流管组.双腔引流管组患者术中放置胰周双腔引流管并在术后行大容量灌洗并持续负压引流;普通引流管组患者术中放置小网膜囊引流管并术后行常规冲洗和引流.观察并比较两组患者治疗效果及引流情况.结果两组在人口统计学数据、胰腺炎的病因和疾病严重程度、手术时间、术中失血量、重症护理时间方面无明显差异.两组术后持续器官衰竭逆转数(84.21%vs 56.25%,P=0.13),严重并发症发生率(16.67%vs 33.33%,P=0.14)无明显差异;总体死亡率为12.28%.尽管无显著的统计学差异(P=0.17),但普通引流管组患者死亡率更高.双腔引流管组APACHEⅡ评分减少幅度更大(8.03±2.13 vs 3.85±1.29,P<0.01),无再手术病例(0 vs 22.22%,P=0.008),住院时间更短,引流管更通畅,能够更早的拔除引流管(P<0.01).结论经双腔引流管大容量灌洗并持持续负压引流是IPN的有效引流方法,可有效治疗IPN.
