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for superior mesenteric artery syndrome


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"Superior mesenteric artery syndrome" governance experience - "Traditional Chinese Medicine" in 1986, 06 of the literature sources CNKI www.cnki.net
Abstract: Department of positive superior mesenteric artery syndrome superior mesenteric artery and duodenum duodenal obstruction caused by a series of symptoms known as the superior mesenteric artery syndrome. The literature also referred to as Wilkic's disease, mesenteric artery obstruction and other names. Superior mesenteric artery syndrome is rare in clinical. Characteristics of clinical manifestations of acute or chronic duodenal obstruction. Where intermittent unexplained recurrent upper abdominal swelling nausea, belching, upper abdominal pain, vomiting, vomiting of bile in the matter, the right lateral position, prone position, knee and elbow position allows the ease, abdominal pain, upper abdominal peristaltic wave and vibration can have the sound of water, should consider the disease. X-ray barium meal is the primary means to determine the disease, has the following four characteristics: 1. Duodenal rampage through the Ministry of barium obstructed, the barium in the spinal column was midline disruptions (or description 【Author】 :
Key words: superior mesenteric artery syndrome superior mesenteric artery syndrome, duodenal obstruction barium unexplained clinical onset of upper abdominal peristaltic wave prone position
】 【DOI: cnki: ISSN :1672-1519 .0.1986-06-008
Snapshot】 【body: Department of the superior mesenteric artery syndrome superior mesenteric artery and duodenum and a series of symptoms of duodenal obstruction caused by superior mesenteric artery syndrome is called. The literature also referred to as Wilkic's disease, mesenteric artery obstruction and other names. Superior mesenteric artery syndrome is rare in clinical. Characteristics of clinical manifestations of acute or chronic duodenal obstruction. Where intermittent unexplained recurrent
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for superior mesenteric artery syndrome

Documents were cited】 【China Academic Journal Europe before the 10 1 NZ! 430071 Wuhan, Liu Yuhua! 430071 Wuhan, Zhang Xiaoguo! 430071 Wuhan; superior mesenteric artery syndrome surgical options [J]; Journal of Clinical Surgery; 02 2000 Hu Yongjun of 2! 450053, Yang! 450053, Wang Dan! 450053, Kang Jin! 450053; acoustic contrast study diagnosis of small bowel intussusception type [J]; Clinical; 2001 01 3 Liu Xinsheng, Hao Xiaoying, Bian Yibo; superior mesenteric artery syndrome in children, diagnosis and surgical treatment [J]; Clinical; 2001 05 4 Song Show! 473000, Wang Gengze! 473000, Wang Yuntang! 473000, Zhao Yuting! 473000; superior mesenteric artery syndrome and treatment [J]; Practical Medicine; 2001 01 5 Zhouxing Xiang, Lu Bin, Yan Jun, Wu Peng, Shengming Hong, Chen Jinglan, Hu Fanglan; gastrointestinal contrast echocardiography combined value of diagnosis of small bowel disease [J]; World Journal of Gastroenterology ; 1999 02 6 YANG Wei-liang; superior mesenteric artery syndrome in surgical treatment [J]; Postgraduates of Medicine; 2000 10 7 Jun Pu, Shi Yu Netherlands; ultrasound diagnosis of intussusception in children to air the entire complex evaluation of the feasibility of [J ]; Shanghai Medical Imaging; 2001 04 8 Liu Yanping, Yu Shi Netherlands, Wang, Qian Feng, Jun Pu; color Doppler pediatric intussusception feasibility study on restoration of air [J]; Shanghai Medical Imaging; 2004 02 9 Jian-Rong Chen! 312000, Zhejiang Province, Nie Yuejuan! 312000, Zhejiang Province, Lv Guoxing! 312000, Zhejiang Province, Li Ting! 312000, Zhejiang Province; improved low-tensioned intestinal disease surveillance ultrasound contrast in the small intestine in the application [J]; Chinese Journal of Ultrasound Medicine; Bu 2001 03 10 Van Hall, Wang whole; closed loop small bowel obstruction in the ultrasonic diagnosis [J]; of Ultrasound in Medicine; 2003 03
Superior mesenteric artery syndrome (superiormesentericartery compression syndrome), also known as wilkie disease, oppression, obstruction, means the superior mesenteric artery and duodenum caused by the level of the Ministry of partial or complete obstruction of the duodenum arising from a series of symptoms.
【】 Medical Education Network Diagnostic collected
According to intermittent abdominal distention after eating, nausea and vomiting, symptoms and body position related to increased supine, prone position, lateral position, reduce, and x-ray contrast showed signs of duodenal horizontal section there is oppression, b or vascular ultrasound Angiography revealed superior mesenteric artery and abdominal aorta when the generally narrow angle to make the diagnosis.
】 【Treatment
Mild symptoms should be controlled diet, bed rest, the best in the prone position, lateral position, nausea and vomiting, intravenous fluids were clear and electrolyte, the majority of patients after symptomatic treatment can be gradually relieve symptoms. After medical therapy, and side to side when possible anastomosis duodenum or jejunum treitz ligament lysis satisfactory outcome Source: Medical Education Network www.med66.com. Source: Medical Education Network www.med66.com
】 【Pathogenesis
Duodenum, superior mesenteric artery and abdominal aorta and the anatomical characteristics of the three the incidence of this disease are closely related. Under normal circumstances, the duodenum in the abdominal aorta and its branches are forward - the angle between the superior mesenteric artery into the duodenum for the diagonal line in front of the superior mesenteric artery, followed by celiac artery and spine, normal by angiography angle 47 ~ 60 °, when the mesentery is too long too short, visceral ptosis, the spine forward and the superior mesenteric artery may be caused by mutation itself. Mesenteric down the stretch, the smaller the angle, often <6 ~ 25 ° and the horizontal part of the duodenum oppression, the formation of intestinal stenosis, duodenal obstruction symptoms arise. Source: Medical Education Network www.med66.com
Clinical manifestations】 【
The disease can occur at any age, but thin, young women were more common or long bed. Was the incidence of chronic intermittent and sustained a few days and relieve itself, but also those who occasionally acute onset. The main clinical manifestations of the performance of duodenal obstruction, upper abdominal fullness after eating, pain, followed by nausea and vomiting, vomiting, large volume, similar to pyloric obstruction, the disease characterized by prominent symptoms and the relevant position, supine position symptoms get worse when the back pressure, and prone position, knee-chest position, the left bit can alleviate the symptoms. Obstruction may be associated with severe dehydration and electrolyte imbalance. Patients may have recurrent weight loss, anemia, malnutrition performance. Neurosis appears there are still some performance.
】 【Auxiliary examination
1. Bowel x-ray contrast: no abnormality in the easing of many found in the onset of visible signs of duodenal compression, in the third paragraph (horizontal side) showed a longitudinal center of the block or knife-like waterfall was falling , barium through the slow, you can stay more than 6 hours in the duodenum, the proximal intestine expansion, and with body position changes on, 20% may be associated with gastric dilatation.
2.b ultrasound examination: Some people think that time ultrasound imaging has high diagnostic value, and proposed diagnostic criteria of this disease: ① drinking water, the superior mesenteric artery and aorta after the angle between, the cross section of intestine duodenum the maximum width of the peristaltic <10mm. ② duodenal descending part of the expansion, Canon> 30mm. ③ b-mode ultrasound showed "bucket-shaped" or "gourd-shaped" image. ④ aorta and superior mesenteric artery angle <13 °.
】 【Differential diagnosis
It should be noted with other diseases caused by differentiated duodenal stasis, such as duodenal tumor, stones, parasites and other diseases outside the duodenum (such as tumors, cysts) of the oppression.
2.
Under normal circumstances, the superior mesenteric artery around the aortic opening the first lumbar level, down into the mesenteric root, the Ministry of the duodenum increased the level of the third lumbar vertebra and the superior mesenteric artery in the aorta between the passage of the distal is Qu (Treitz) after abdominal ligament fixed, the general said, between the aorta and superior mesenteric artery angle of more than 45 degrees, distance of more than 7 mm, when the small bowel mesentery and abdominal wall after the fixed-tight; the superior mesenteric artery and the opening is too low or become smaller aortic angulation; visceral fat, sagging or too little, Department of membrane; lumbar scoliosis so severe the emergence of the disease may be induced. It called a "superior mesenteric artery syndrome."
The clinical symptoms of duodenal stasis varying severity, but also no obvious symptoms, generally have a sense of abdominal fullness, nausea, vomiting, heating or other abdominal discomfort, some patients preferred the right lateral position or prone position and relieve symptoms.
So I think a diagnosis of "superior mesenteric artery syndrome" more clear, more support or symptoms and signs, but the light can not be diagnosed CT examination, X-ray barium meal examination required as a basis for diagnosis.
Treatment can be applied atropine, palate, urge sympathy or intramuscular injection, to maintain electrolyte balance, non-surgical treatment may be considered not significantly improved after surgery.
3.
Barium meal, abdominal color Doppler ultrasound of superior mesenteric artery compression syndrome is simple, reliable diagnostic tool. Speaking in front of a lot of brothers have been very good
Talk focused on the treatment of the following questions:
Superior mesenteric artery syndrome after mild symptoms may be alleviated medical symptomatic and supportive treatment, surgical treatment to be ineffective, surgical methods to treat the underlying disease.
1. Gastrectomy, completion type â…¡ gastrojejunostomy: This surgical combination for duodenal ulcer.
2. Duodenal vascular advancement surgery: cutting ligament of Treit
z, free music and duodenal duodenum jejunum rose section, cross section. Cut and ligation of inferior pancreaticoduodenal artery and vein branch, removal of part of a blood circulation disorder cross section of bowel and duodenum, and then forward in the superior mesenteric artery anastomosis. The surgical procedures for patients with mild symptoms, has formed a habit of reverse peristalsis were ineffective.
3. Duodenal anastomosis: This method is recognized as an effective surgical procedure, and patients should note the following: 1) proper separation of transverse mesocolon, duodenum exposed as much as possible in order to prevent postoperative adhesions. 2) the proximal anastomosis the superior mesenteric artery should be as close as possible to reduce the blind loop in order to avoid "blind-side syndrome" formation. 3) The anastomosis should be large enough to avoid anastomotic stenosis. 4) distal anastomosis without tension case, should be as close to the Treitz ligament.
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