肠系膜上动脉综合征的诊治:附11 例报告
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孔凡民, Email: kong_fanmin@yahoo.com.cn

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Diagnosis and treatment of superior mesenteric artery syndrome: a report of 11 cases
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    摘要:

    目的:探讨肠系膜上动脉综合征(SMAS)的诊疗方法,旨在提高对本病的认识,以降低误诊率。 方法:对中国医科大学附属第一医院1992年6月—2012年6月期间病历完整的11例SMAS患者行回顾性分析。 结果:11例中男7例,女4例,男女比例为1.75:1,以14~25岁高发(72.7%);均以上腹部饱胀不适作为首发症状就诊,伴恶心、呕吐6例(54.5%,6/11),消瘦7例(63.6%,7/11);上消化道全程造影过程中见明显肠管逆蠕动4例,出现典型“钟摆样运动”1例,4例有肠系膜上动脉压迹;CT检查中3例显示肠系膜上动脉与腹主动脉夹角明显减小(<22°);7例行静脉营养支持等保守治疗,4例保守治疗失败给予手术治疗,均恢复良好。8例患者术后随访6~102个月,均无复发及其他并发症。 结论:SMAS临床上相对少见,易于误诊,应加强对本病的认识,熟悉其诊断与治疗方法。

    Abstract:

    Objective: To investigate the diagnosis and treatment strategies of superior mesenteric artery syndrome (SMAS), for improving the understanding and reducing misdiagnosis of this disease. Methods: Eleven SMAS patients admitted to the First Affiliated Hospital of China Medical University during June 1992 to June 2012, who had complete medical records were reviewed. Results: Of the 11 patients, 7 cases were male and 4 cases were female (male:female 1.75:1), with a high incidence from the age of 14 to 25 years (72.7%); Upper abdominal bloating and discomfort were the initial symptoms for medical attention in all cases, and were accompanied by nausea and vomiting in 6 cases (54.5%) and emaciation in 7 cases (63.6%); during the whole upper gastrointestinal radiography, apparent reverse peristalsis of the intestine was observed in 4 cases, typical "pendulum-like movement" occurred one case, and impression of the mesenteric artery over the duodenum was found in 4 cases; CT examination showed the angle between the superior mesenteric artery and the abdominal aorta was reduced (<22°) in 3 cases; 7 cases received conservative treatment such as intravenous nutrition support, and 4 cases underwent surgical treatment due to failure of conservative treatment, and all recovered after treatment. Eight patients were followed up for 6 to 12 months, and no recurrences or complications were noted. Conclusion: SMAS is relatively rare in clinical practice and easy to be misdiagnosed. Knowledge regarding this disease should be enhanced, and its diagnostic methods and treatment modalities should be standardized.

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马超,孔凡民.肠系膜上动脉综合征的诊治:附11 例报告[J].中国普通外科杂志,2014,23(12):1672-1675.
DOI:10.7659/j. issn.1005-6947.2014.12.014

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  • 收稿日期:2014-02-08
  • 最后修改日期:2014-06-20
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  • 在线发布日期: 2014-12-15