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Abstract：
BACKGROUND: Superior mesenteric artery syndrome (SMAS) is a rare condition causing functional obstruction of the third portion of the duodenum. Postoperative SMAS following laparoscopic-assisted radical right hemicolectomy is even less prevalent and can often be unrecognized by radiologists and clinicians.
OBJECTIVE: To analyze the clinical features, risk factors, and prevention of SMAS after laparoscopic-assisted radical right hemicolectomy.
METHODS: We retrospectively analyzed clinical data of 256 patients undergoing laparoscopic-assisted radical right hemicolectomy in the Affiliated Hospital of Southwest Medical University from January 2019 to May 2022. The occurrence of SMAS and its countermeasures were evaluated. Among the 256 patients, SMAS was confirmed in six patients (2.3%) by postoperative clinical presentation and imaging features. All six patients were examined by enhanced computed tomography (CT) before and after surgery. Patients who developed SMAS after surgery were used as the experimental group. A simple random sampling method was used to select 20 patients who underwent surgery at the same time but did not develop SMAS and received preoperative abdominal enhanced CT as the control group. The angle and distance between the superior mesenteric artery and abdominal aorta were measured before and after surgery in the experimental group and before surgery in the control group. The preoperative body mass index (BMI) of the experimental group and the control group was calculated. The type of lymphadenectomy and surgical approach in the experimental and control groups were recorded. The differences in angle and distance were compared preoperatively and postoperatively in the experimental group compared. The differences in angle, distance, BMI, type of lymphadenectomy and surgical approach between the experimental and control groups were compared, and the diagnostic efficacy of the significant parameters was assessed using receiver operating characteristic curves.
RESULTS: In the experimental group, the aortomesenteric angle and distance after surgery were significantly decreased than those before surgery (P < 0.05). The aortomesenteric angle, distance and BMI were significantly higher in the control group than in the experimental (P < 0.05). There was no significant difference in the type of lymphadenectomy and surgical approach between the two groups (P > 0.05).
CONCLUSIONS: The small preoperative aortomesenteric angle and distance and low BMI may be important factors for the complication. Over-cleaning of lymph fatty tissues may also be associated with this complication.
OBJECTIVE: To analyze the clinical features, risk factors, and prevention of SMAS after laparoscopic-assisted radical right hemicolectomy.
METHODS: We retrospectively analyzed clinical data of 256 patients undergoing laparoscopic-assisted radical right hemicolectomy in the Affiliated Hospital of Southwest Medical University from January 2019 to May 2022. The occurrence of SMAS and its countermeasures were evaluated. Among the 256 patients, SMAS was confirmed in six patients (2.3%) by postoperative clinical presentation and imaging features. All six patients were examined by enhanced computed tomography (CT) before and after surgery. Patients who developed SMAS after surgery were used as the experimental group. A simple random sampling method was used to select 20 patients who underwent surgery at the same time but did not develop SMAS and received preoperative abdominal enhanced CT as the control group. The angle and distance between the superior mesenteric artery and abdominal aorta were measured before and after surgery in the experimental group and before surgery in the control group. The preoperative body mass index (BMI) of the experimental group and the control group was calculated. The type of lymphadenectomy and surgical approach in the experimental and control groups were recorded. The differences in angle and distance were compared preoperatively and postoperatively in the experimental group compared. The differences in angle, distance, BMI, type of lymphadenectomy and surgical approach between the experimental and control groups were compared, and the diagnostic efficacy of the significant parameters was assessed using receiver operating characteristic curves.
RESULTS: In the experimental group, the aortomesenteric angle and distance after surgery were significantly decreased than those before surgery (P < 0.05). The aortomesenteric angle, distance and BMI were significantly higher in the control group than in the experimental (P < 0.05). There was no significant difference in the type of lymphadenectomy and surgical approach between the two groups (P > 0.05).
CONCLUSIONS: The small preoperative aortomesenteric angle and distance and low BMI may be important factors for the complication. Over-cleaning of lymph fatty tissues may also be associated with this complication.
摘要：
背景：肠系膜上动脉综合征（SMAS）是一种引起十二指肠第三部分功能性梗阻的罕见疾病。腹腔镜辅助根治性右半结肠切除术后的SMAS甚至不那么普遍，并且通常无法被放射科医生和临床医生识别。
目的：分析临床特征，危险因素，腹腔镜辅助根治性右半结肠切除术后SMAS的预防。
方法：回顾性分析2019年1月至2022年5月在西南医科大学附属医院行腹腔镜辅助根治性右半结肠切除术的256例患者的临床资料。评估了SMAS的发生及其对策。在256名患者中，通过术后临床表现和影像学特征证实了6例患者（2.3％）的SMAS。所有6例患者均在手术前后进行了增强计算机断层扫描（CT）检查。将术后出现SMAS的患者作为实验组。采用简单随机抽样的方法,选择20例同时行手术但未发生SMAS且术前接受腹部增强CT检查的患者作为对照组。实验组手术前后和对照组手术前测量肠系膜上动脉与腹主动脉的夹角和距离。计算实验组和对照组的术前体重指数(BMI)。记录实验组和对照组的淋巴结清扫类型和手术方式。比较两组患者术前和术后角度和距离的差异。角度的差异，距离,BMI,比较实验组和对照组的淋巴结清扫类型和手术方式，并使用受试者工作特征曲线评估重要参数的诊断效能。
结果：在实验组中，手术后主动脉肠系膜角度和距离较术前明显减小(P<0.05)。主动脉肠系膜角,对照组的距离和BMI明显高于实验组(P<0.05)。两组淋巴结清扫方式及手术方式比较差异无统计学意义(P>0.05)。
结论：术前主动脉肠系膜角度和距离小，BMI低可能是并发症的重要因素。淋巴脂肪组织的过度清洁也可能与这种并发症有关。
目的：分析临床特征，危险因素，腹腔镜辅助根治性右半结肠切除术后SMAS的预防。
方法：回顾性分析2019年1月至2022年5月在西南医科大学附属医院行腹腔镜辅助根治性右半结肠切除术的256例患者的临床资料。评估了SMAS的发生及其对策。在256名患者中，通过术后临床表现和影像学特征证实了6例患者（2.3％）的SMAS。所有6例患者均在手术前后进行了增强计算机断层扫描（CT）检查。将术后出现SMAS的患者作为实验组。采用简单随机抽样的方法,选择20例同时行手术但未发生SMAS且术前接受腹部增强CT检查的患者作为对照组。实验组手术前后和对照组手术前测量肠系膜上动脉与腹主动脉的夹角和距离。计算实验组和对照组的术前体重指数(BMI)。记录实验组和对照组的淋巴结清扫类型和手术方式。比较两组患者术前和术后角度和距离的差异。角度的差异，距离,BMI,比较实验组和对照组的淋巴结清扫类型和手术方式，并使用受试者工作特征曲线评估重要参数的诊断效能。
结果：在实验组中，手术后主动脉肠系膜角度和距离较术前明显减小(P<0.05)。主动脉肠系膜角,对照组的距离和BMI明显高于实验组(P<0.05)。两组淋巴结清扫方式及手术方式比较差异无统计学意义(P>0.05)。
结论：术前主动脉肠系膜角度和距离小，BMI低可能是并发症的重要因素。淋巴脂肪组织的过度清洁也可能与这种并发症有关。
