| Background and ObjectiveSuperior mesenteric artery syndrome(SMAS)is a rare clinical disease,with a low incidence rate and complex etiology.The root cause is that the third or fourth parts of the duodenum were oppressed by the Superior mesenteric artery or its branches,resulting in the obstructed passage of the duodenum.Its clinical manifestations are non-specific,often manifested as abdominal pain,bloating,vomiting,anorexia and many other common gastrointestinal diseases,misdiagnosis and mistreatment are more common.Some people suggest conservative treatment,but the time and effect of conservative treatment is still inconclusive,the surgical treatment focuses on the effect of single surgery,and the selection of specific surgical methods for different individuals does not form a fixed standard,and lacks long-term therapeutic effects follow-up analysis.We adjusted the diagnosis and treatment plan for patients with different conditions,conducted regular follow-up,combined with case data to explore the diagnosis and laparoscopic treatment strategy and efficacy of SMAS.MethodsRetrospective analysis of the clinical data of 76 patients with superior mesenteric artery syndrome who were admitted to our hospital from January 2010 to June 2018,including the diagnosis procedure,surgical plan,follow-up results,and the diagnosis and laparoscopic treatment strategy and efficacy of SMAS were summarized.Results76 cases(100%)were eventually diagnosed,and the diagnosis strategy was summarized based on the case data.All patients were done in laparoscopic surgery.The average operation time of 35 cases of laparoscopic duodenojejunostomy was 148.4 min(148.4±41.1),the average blood loss was 40 ml(40±21.6),28 cases(80%)were cured,and the recovery period was 5.1 months(5.14±3.35),the average postoperative body mass index was 21.1kg/m~2(21.14±1.53).15 cases of laparoscopic gastroduodenal double shortcut anastomosis with a median operation time of 250min(200min,275min),median blood loss 50ml(30 ml,65 ml),11 cases(73.3%)were cured,the median recovery period was 3 months(2 months,6 months),the postoperative median body mass index was 19.5 kg/m~2(19.1 kg/m~2,21.65 kg/m~2).10cases of laparoscopic gastroplasty plus duodenojejunostomy were performed at a median operation time of 300 min(275 min,300 min),median blood loss 50 ml(30ml,65 ml),and 9 cases(90%)were cured,the median recovery period was1 month(0month,1 month),and the postoperative median body mass index was 18.95 kg/m~2(16kg/m~2,20.2 kg/m~2).The median operation time of 16 cases of laparoscopic gastrojejunostomy was 180min(150min,195min),the median blood loss was 50ml(30ml,50ml),12 cases(75%)were cured,and median recovery period was 4 months(3 months,5.5 months),the postoperative median body mass index was 21.3 kg/m~2(20.25 kg/m~2,21.95 kg/m~2).The body mass index of 76 patients before and after operation was compared p<0.05.The difference was statistically significant,indicating that the surgical treatment can increase the weight of the patient and the surgical treatment is satisfactory.Laparoscopic duodenojejunostomy group,laparoscopic gastroduodenal double shortcut anastomosis group,laparoscopic gastroplasty plus duodenojejunostomy group,the preoperative medical history,gastroptosis degree(distance),operation time,intraoperative blood loss,recovery time(postoperative recovery period)between the three groups were compared all p<0.05,with statistically significant differences.The results showed that the patient’s preoperative medical history and the degree of gastroptosis could be used as the basis for the selection of individualized surgical methods.The recovery period of the gastroduodenal double shortcut anastomosis group and the gastroplasty plus duodenojejunostomy group was lower than that of the duodenojejunostomy group.ConclusionsThe diagnosis strategy based on upper gastrointestinal imaging can strengthen the clinician’s understanding of the diagnostic method,and help to improve the diagnosis rate.The surgical treatment strategy based on duodenojejunostomy can shorten the postoperative recovery period,improve prognosis and help improve cure rate.The"Double core,Double strategy"concept of diagnosis and treatment provides a basis for standardized diagnosis and treatment. |
