Therapeutic laparoscopy for superior mesenteric artery syndrome in 5 children: treatment experience and lite-rature review
10.3760/cma.j.cn101070-20220523-00598
- VernacularTitle:儿童肠系膜上动脉压迫综合征5例腹腔镜治疗体会并文献复习
- Author:
Hao CHEN
1
;
Xiaogang SUN
;
Dianguo LI
;
Weixiu CHEN
Author Information
1. 福建医科大学附属泉州第一医院小儿外科，泉州 362000
- Keywords:
Superior mesenteric artery syndrome;
Release of the ligament of Treitz;
Laparoscopy;
Child
- From:
Chinese Journal of Applied Clinical Pediatrics
2022;37(24):1903-1906
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical characteristics and therapeutic laparoscopy treatment for superior mesenteric artery syndrome(SMAS) in children.Methods:A retrospective study on 5 children with SMAS who failed to respond to the conservative treatment in the Second Hospital of Shandong University from March 2017 to March 2022 was carried out.All the patients underwent the laparoscopic lysis of the ligament of Treitz and duodenal lowering procedure.The clinical data were analyzed and literature retrieved from Wanfang and PubMed databases were reviewed.Results:There were 3 boys and 2 girls in the 5 cases with SMAS.The average age was (12.4±1.4) years, and the preoperative body mass index was (15.2±0.8) kg/m 2.The patients were admitted to the hospital with vomiting, abdominal pain and emaciation symptoms, and the duration of symptoms was (8.4±7.8) months.Gastroscopy, laparoscopic lysis of the ligament of Treitz and duodenal lowering procedure were performed successfully in all the patients, without conversions to open surgery.The average operation duration was (66.0±10.7) min.Food intake was allowed 1 day after surgery.Chylous fistula occurred 4 days after operation in one patient, whose symptom relieved after 11 days of conservative treatment.One patient still had nausea and vomiting symptoms 10 days after operation and was healed by knee-chest posture treatment.No other short-term complications were observed.The median postoperative duration of stay in the hospital was 7 (6-22) days.The patients were followed up for 9-56 (median: 21) months.All of them recovered well and gained weight.One patient had mild recurrent symptoms, and was cured after conservative treatment.A total of 15 literature on the treatment of SMAS by laparoscopic lysis of the ligament of Treitz was retrieved, and the cure rate was 40%-100%.Only one group of these cases had a cure rate below 75%. Conclusions:The laparoscopic lysis of the ligament of Treitz and duodenal lowering procedure is safe, effective, simple and minimally invasive treatment for children with SMAS.It can be used as the first choice for most pediatric patients.
