目的 对小儿肠系膜上动脉压迫综合征(superior mesenteric artery syndrome, SMAS)的临床诊断和术式选择进行评价。 方法 总结2000年8月至2015年1月经作者手术治疗的12例SMAS患儿临床资料,并结合文献就其病因、诊断及手术方式进行分析。 结果 本组12例均行上消化道造影检查,都显示钡剂通过十二指肠水平段受阻,表现为典型的纵行“笔杆征”压迹,3例钡剂在胃和十二指肠内形成明显的反复交流的“钟摆样”运动。所有患儿均经保守治疗无效而行手术治疗,其中十二指肠空肠侧侧吻合术4例,十二指肠空肠侧侧吻合加Treitz韧带松解术2 例,Ladd手术 4例,肠系膜上血管前十二指肠空肠吻合术2例,均痊愈出院,无并发症发生。随访6个月至10年,3例早期复发,经保守治疗痊愈。 结论 上消化道钡剂造影是SMAS主要的确诊手段。本病保守治疗无效需手术治疗,其手术方式多样,可根据不同病理类型选择相应术式,凡能解除机械性梗阻而无明显弊端的术式均可采用,十二指肠空肠侧侧吻合术及Ladd手术值得推荐。
Objective To evaluate the clinical diagnosis and operative modality of superior mesenteric artery syndrome(SMAS)in children. Methods The clinical data were collected for 12 SMAS children undergoing surgery from August 2000 to January 2015. And their pathogenesis, diagnosis and treatment were analyzed. Results The results of upper gastrointestinal contrast revealed barium obstruction with a classic vertical impression of penholder sign in horizontal duodenum. Three cases showed that barium flowed repeatedly between stomach and duodenum as a pendulum sign. All of them were operated after failed conservative treatment. The surgical procedures included side-to-side duodenojejunostomy(n=4), side-to-side duodenojejunostomy plus lysis of Treitz ligament(n=2), Ladd's surgery(n=4)and anterior duodenojejunostomy(n=2). All of them were cured and discharged without complications. After a follow-up period of 6 months to 10 years, 3 cases of early relapse were cured conservatively. Conclusion s The diagnosis of SMAS is dependent upon upper gastrointestinal contrast examination. Surgery is indicated if conservative treatment is ineffective. The choice of surgical approaches is determined by pathological types. Any method of completely eliminating mechanical obstruction factors without side effects may be utilized. Side-to-side duodenojejunostomy and Ladd's surgery are worthy of popularization.
