肠系膜上动脉综合征(SMAS)是十二指肠阻塞的罕见病因,由于肠系膜上动脉和主动脉之间的十二指肠受压。这个前瞻性注册表旨在描述人口统计,临床,和SMAS患者的预后特征,并指出手术指征。
在2008年至2016年之间,包括患有慢性胃肠道症状和SMAS诊断的患者。人口统计,临床表现,诊断,并记录手术结果。用标准化问卷调查症状。诊断是通过钡吞下,CT/MR血管造影(主动脉肠系膜角度≤22°,距离≤8mm),内窥镜检查。所有患者均接受十二指肠空肠吻合术±十二指肠远端切除术。在后续行动中,重新评估症状评分和咽钡.
39名患者(11米/28华氏度,中位年龄38岁,中位数BMI17.8kg/m2)包括在内。57%的患者出现胃十二指肠扩张,38%的胃十二指肠排空延迟。主动脉肠系膜正中角度为11°,距离为5mm。所有患者均行十二指肠空肠吻合术,在32名患者中,还进行了远端十二指肠切除术.中位随访时间为47个月,总体症状评分显著下降(10vs.32,p<0.0001)和BMI增加(19.5vs.17.8,p<0.0001)。术后2个月,有38%的术前病理发现的患者在胃十二指肠扩张和排空方面表现出改善。
SMAS是一种罕见的疾病,在慢性疾病中应该被怀疑,难治性上消化道症状,尤其是BMI较低的女性。手术治疗可以改善症状和生活质量,尽管它不是在所有情况下都能治愈。ClinicalTrials.gov标识符:NCT03416647。
Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction, resulting from the compression of the duodenum between superior mesenteric artery and aorta. This prospective registry aims to describe demographic, clinical, and outcome features of patients suffering from SMAS and to point out the indications for surgery.
Between 2008 and 2016, patients with chronic gastrointestinal symptoms and diagnosis of SMAS were included. Demographics, clinical presentation, diagnosis, and surgical outcome were recorded. Symptoms were investigated with a standardized questionnaire. The diagnosis was achieved through barium swallow, CT/MR angiography (aortomesenteric angle ≤ 22°, distance ≤ 8 mm), endoscopy. All patients underwent duodenojejunostomy ± distal duodenum resection. At follow-up, symptom score and barium swallow were re-evaluated.
Thirty-nine patients (11 M/28 F, median age 38 years, median BMI 17.8 kg/m2) were included. Barium swallow showed a gastroduodenal dilation in 57% of patients, and a delayed gastroduodenal emptying in 38%. Median aortomesenteric angle was 11° and distance was 5 mm. All patients underwent duodenojejunostomy, and in 32 patients, a distal duodenum resection was also performed. At a median follow-up of 47 months, the overall symptom score significantly dropped (10 vs. 32, p < 0.0001) and BMI increased (19.5 vs. 17.8, p < 0.0001). Barium swallow at 2 months postoperatively showed an improvement in terms of gastroduodenal dilation and emptying in 38% of patients with preoperative pathological findings.
SMAS is a rare condition that should be suspected in cases of chronic, refractory upper digestive symptoms, particularly in females with low BMIs. Surgical treatment may improve symptoms and quality of life, although it is not curative in all cases. ClinicalTrials.gov Identifier: NCT03416647.