十二指肠空肠吻合术治疗肠系膜上动脉综合征的评价

目的:评价十二指肠空肠吻合术治疗肠系膜上动脉综合征((SMAS)的价值。方法:分析1959年1月—2012年12月采用十二指肠空肠吻合术治疗的SMAS88例患者的临床资料。结果:本组患者主要症状为餐后上腹胀痛和频繁呕吐,呕吐物含胆汁;经CT检查结合X线钡餐造影诊断为SMAS。88例均经手术治疗,其中70例(79.5%)效果优良,痊愈出院;18例(20.5%)效果不良,又出现术前症状,术后2周~3个月再行钡餐X线造影显示十二指肠空肠吻合口通畅,十二指肠逆蠕动仍然强烈,逆蠕动顺蠕动,钡剂逆流入胃,胃扩张无力。此18例二次改行十二指肠环形引流术,术后痊愈。结论:SMAS一旦成为习惯性逆蠕动,就难以消除,即使行十二指肠空肠吻合术解除十二指肠梗阻,临床症状也不能改善,其治疗关键是解决逆蠕动问题。采用十二指肠环形引流术能解决十二指肠内容物的引流方向,使呕吐等症状消除。

Evaluation of cuodenum jeunum anastomosis in treatment of superior mesenteric artery syndrome

Objective： To evaluate the value of jejunoduodenostomy operation to treat superior mesenteric artery syndrome （SMAS）. Methods： Eighty eight cases of superior mesenteric artery syndrome were treated with jejunoduodenostomy from January 1959 to December 2012. Clinical da- ta were analyzed retrospectively. Results- In this group, the diagnosis of SMAS should mainly de- pend on CT scanning combined with barium meal examination with the typical clinical manifestations such as epigastric distending pain and frequent vomiting after meals, throwing up bile. All the 88cases underwent surgical procedures in which 70 cases（79.5%） were healed and had good ef- fect, 18 cases（20.5%） of adverse effect and recurrence during the clinical follow up. After 2 week-3 month, the barium meal examination showed duodenum jejunum anastomotic patency, reversed peristalsis of duodenum still strong, and reversed peristalsis〉 iso-peristalsis, barium reflux into the stomach and the stomach dilatation weakness. These 18 cases were recovered after underwent duodenal circular drainage operation. Conclusion： In SAMS, the habitual reversed peristalsis can not be relieved even if the obstruction of duodenum is removed by operation. The key treatment is the relief of reversed peristalsis. Only the duodenal circular drainage operation could resolve the drainage direction of duodenal content and relieve the symptom of vomiting.