- 期刊
- OpenAccess
Superior Mensenteric Artery Syndrome
上腸系膜動脈徵候群
摘要
上腸系膜動脈徵候群乃一種較不常見的疾病；文獻上報告之病例大約只有四百例左右。三軍總醫院近年來發現三例，特提出報告。此疾病可因許多因素造成，其乃因上腸系膜動脈與主動脈間的角度在某些情況下會變狹小，造成似老虎鉗之效果而壓迫到兩者之間的十二指腸橫部，造成高位腸阻塞的症狀。其原因可包括先天上解剖位置之變異、長期仰臥、軀體石膏使身體處於過度伸展狀態或某些原因使體重急速減輕。其診斷方法除靠臨床表徵似高位腸阻塞外，最重要者乃上腸胃鋇劑檢查同時加上螢光透視，其可見典型之十二指腸擴大及鋇劑來回翻攪現象。在治療方面，保守之姿勢治療可幫助一部份病人；另一部份病人則需外科手術。手術方法一般常用者有三：Treitz韌帶之切斷術，十二指腸空腸吻合術及胃空腸吻合加上迷走神經切斷術。吾等三位病例在術前均有正確診斷且均經十二指腸空腸吻合術而解除病症，故我們同意對此疾病而言，十二指腸空腸吻合術乃一良好而值得選擇的治療方法。
並列摘要
Superior mesenteric artery (SMA) syndrome is an uncommon disease. Only about 400 cases have been published in the literature. Three cases are reported here. The lesion may result from multiple factors that create a vise-like effect at the transverse portion of the duodenum by SMA-aortic compression. Etiological factors include anatomical variation, supine immobilization, wearing a body cast, and rapid weight loss. Diagnosis was best made by upper gastrointestinal barium study plus cinefluoroscopy. A dilated duodenum, and a churning, to-and-fro motion of the barium column were commonly noted. Conservative modalities provide relief in a few patients. Surgical management may be required in others, including duodenojejunostomy, division of the ligament of Treitz and gastrojejunostomy with vagotomy. In all three cases duodenojejunostomy was performed with good results. We agree that duodenojejunostomy today is considered the proper procedure of choice for surgical treatment of this syndrome.