本文選題：腸系膜上動脈壓迫綜合征　切入點：腹腔鏡　出處：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景和目的腸系膜上動脈壓迫綜合征(Superior mesenteric artery compressing syndrome,SMACS)是因十二指腸水平部或升部被腸系膜上動脈或其分支壓迫,十二指腸近端出現(xiàn)淤滯、擴張,進而引起的一系列十二指腸通過障礙的癥狀,其中餐后腹痛、嘔吐為主要癥狀,呈間歇性,取左側(cè)臥位、胸膝位或俯臥位癥狀�？删徑饣蛎黠@減輕,緩解期可出現(xiàn)非特異性上消化道癥狀,SMACS發(fā)病率低、臨床表現(xiàn)無特異性、無標(biāo)準(zhǔn)診治方案,患者容易被長期誤診誤治,患者長期反復(fù)發(fā)作可出現(xiàn)營養(yǎng)不良、貧血、電解質(zhì)代謝紊亂,甚至精神神經(jīng)癥狀。本文主要探討SMACS的診斷和腹腔鏡手術(shù)治療經(jīng)驗。方法回顧性分析我院2006年10月至2016年5月行完全腹腔鏡手術(shù)治療的62例SMACS患者臨床資料、診斷方法、隨訪結(jié)果進而總結(jié)手術(shù)方式選擇經(jīng)驗。結(jié)果本組患者行上消化道造影檢查共62例,確診59例;CT血管造影(computer tomography angiography,CTA)檢查44例,確診31例;超聲檢查38例,確診26例。本組62例中采取完全腹腔鏡十二指腸空腸吻合術(shù)41例,完全腹腔鏡胃腸吻合14例,完全腹腔鏡胃十二指腸雙捷徑吻合術(shù)7例,患者均緩解或痊愈出院,術(shù)后隨訪總體效果滿意。結(jié)論SMACS首選輔助診斷方法是上消化道造影,超聲或CTA測量腹主動脈與腸系膜上動脈夾角能提供參考;對于反復(fù)發(fā)作且保守治療效果不佳的患者,建議早期手術(shù),以完全腹腔鏡十二指腸空腸吻合術(shù)為主要術(shù)式;SMACS的腹腔鏡手術(shù)治療安全,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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.2

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