肠系膜上动脉压迫综合征的诊断和腹腔镜手术治疗

发布时间：2018-04-04 12:35

本文选题：肠系膜上动脉压迫综合征　切入点：腹腔镜　出处：《郑州大学》2017年硕士论文

【摘要】：背景和目的肠系膜上动脉压迫综合征(Superior mesenteric artery compressing syndrome,SMACS)是因十二指肠水平部或升部被肠系膜上动脉或其分支压迫,十二指肠近端出现淤滞、扩张,进而引起的一系列十二指肠通过障碍的症状,其中餐后腹痛、呕吐为主要症状,呈间歇性,取左侧卧位、胸膝位或俯卧位症状常可缓解或明显减轻,缓解期可出现非特异性上消化道症状,SMACS发病率低、临床表现无特异性、无标准诊治方案,患者容易被长期误诊误治,患者长期反复发作可出现营养不良、贫血、电解质代谢紊乱,甚至精神神经症状。本文主要探讨SMACS的诊断和腹腔镜手术治疗经验。方法回顾性分析我院2006年10月至2016年5月行完全腹腔镜手术治疗的62例SMACS患者临床资料、诊断方法、随访结果进而总结手术方式选择经验。结果本组患者行上消化道造影检查共62例,确诊59例;CT血管造影(computer tomography angiography,CTA)检查44例,确诊31例;超声检查38例,确诊26例。本组62例中采取完全腹腔镜十二指肠空肠吻合术41例,完全腹腔镜胃肠吻合14例,完全腹腔镜胃十二指肠双捷径吻合术7例,患者均缓解或痊愈出院,术后随访总体效果满意。结论SMACS首选辅助诊断方法是上消化道造影,超声或CTA测量腹主动脉与肠系膜上动脉夹角能提供参考;对于反复发作且保守治疗效果不佳的患者,建议早期手术,以完全腹腔镜十二指肠空肠吻合术为主要术式;SMACS的腹腔镜手术治疗安全,可靠。
[Abstract]:Background and objective Superior mesenteric artery compressing syndrome (SMACSs) is caused by the superior mesenteric artery or its branches, and the proximal end of the duodenum becomes stagnant and dilated.A series of symptoms caused by duodenal obstruction, including postprandial abdominal pain, vomiting as the main symptoms, intermittent, take the left lying position, chest and knee position or prone position symptoms can often be alleviated or significantly alleviated,In remission stage, the incidence of SMACS is low, the clinical manifestation is nonspecific, and there is no standard diagnosis and treatment plan. The patients are liable to be misdiagnosed and mistreated for a long time, and the patients may suffer from malnutrition and anemia after repeated attacks for a long time.Electrolyte metabolic disorders, and even psychiatric symptoms.This article mainly discusses the diagnosis of SMACS and the experience of laparoscopic surgery.Methods the clinical data and diagnostic methods of 62 patients with SMACS undergoing complete laparoscopic surgery from October 2006 to May 2016 were analyzed retrospectively.Results Sixty-two cases were examined by upper gastrointestinal angiography, 44 cases were diagnosed by CT angiography, 31 cases were diagnosed by CT angiography, 38 cases were diagnosed by ultrasonography, 26 cases were diagnosed by ultrasonography.There were 41 cases of complete laparoscopic duodenojejunostomy, 14 cases of complete laparoscopic gastroenterostomy and 7 cases of complete laparoscopic gastroduodenal double shortcut anastomosis.Conclusion the first auxiliary diagnostic method of SMACS is upper gastrointestinal angiography. The angle between abdominal aorta and superior mesenteric artery can be measured by ultrasonography or CTA.Complete laparoscopic duodenojejunostomy as the main operative method SMACS laparoscopic surgery is safe and reliable.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.2

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