摘要目的 探讨运用腹腔镜行十二指肠空肠吻合术治疗儿童肠系膜上动脉压迫综合征(S u-perior mesenteric artery syndrome,SMAS)的安全性及可行性,总结其诊断、手术治疗经验及疗效.方法 回顾性分析广西医科大学第一附属医院小儿外科2016年4月至2018年12月行完全腹腔镜手术治疗的22例SM AS患儿的临床资料.其中男13例,女9例,平均年龄为11岁3个月.患儿就诊时症状为腹痛及恶心22例,伴呕吐7例.术前22例均行上消化道造影及胃镜检查,其中21例接受C T血管造影及彩色多普勒超声检查,测量肠系膜上动脉与腹主动脉夹角及距离.结果 对22例患儿行上消化道造影后均确诊为SMAS;CT血管造影检查21例,确诊18例;彩色多普勒超声检查21例,确诊17例,上消化道造影、CT血管造影及彩色多普勒超声对SMAS的检出率对比,差异无统计学意义(P<0.05).胃镜均提示慢性胃炎,其中6例合并十二指肠炎.行腹腔镜下十二指肠空肠侧侧吻合22例,术后胃肠道功能恢复时间为1～3d,平均时间为2d,术中出血量为5～20ml,术后第四天起进食流质,术后7 d出院,随访2个月至2年4个月,平均11个月,22例患儿中有20例痊愈或缓解,有效率90.9％,疗效满意;其中1例发生吻合口狭窄,无吻合口漏、狭窄、出血及粘连性肠梗阻等并发症;2例疗效不佳的患儿中,1例为吻合口狭窄,经球囊扩张后好转,另1例的疗效不佳的原因考虑与胆汁反流有关.结论 上消化道造影、CT血管造影及彩色多普勒超声检查对SMAS有重要的诊断价值;腹腔镜下十二指肠空肠侧侧吻合治疗儿童肠系膜上动脉压迫综合征具有操作简单、创伤小、恢复快、疗效佳等优点,值得推广应用.

abstractsObjective To evaluate the therapeutic safety and feasibility of laparoscopic duodenojejunostomy for superior mesenteric artery syndrome (SMAS) in children and summarized the methods of diagnosis , surgical treatments and outcomes .Methods A retrospective analysis was conducted for 22 SMAS children undergoing total laparoscopy from April 2016 to December 2018 . There were 13 boys and 9 girls with a mean age of 135 months .The clinical manifestations included abdominal pain (n=22) ,nausea (n= 22) and vomiting (n= 7) .Upper gastrointestinal angiography (n=22) and CT angiography and color Doppler ultrasonography (n = 21 ) were performed for measuring the angle and distance between superior mesenteric artery and abdominal aorta .Results All of them were definitely diagnosed by upper gastrointestinal angiography .CT angiography and Doppler ultrasonography examination could only make a definite diagnosis in 18 and 17 cases .No significant difference existed in diagnostic rate among upper gastrointestinal angiography ,color Doppler ultrasonography and CT (P< 0 .05) .Gastroscopy revealed chronic gastritis and concurrent duodentis (n=6) .All cases underwent successful laparoscopic duodenojejunostomy and side-to-side anastomosis . The average&nbsp;postoperative recovery time of gastrointestinal function was 2(1-3) days ,intraoperative blood loss 5-20 ml ,feeding resumed partially at 4 days and discharge occurred at 7 days .All cases were available at the final follow-up .During an average follow-up period of 11(2-28) months ,20 cases were cured or alleviated with an effective rate of 90 .9％ .There was only 1 case of anastomotic stenosis .Among two cases of poor efficacy ,one case of anastomotic stenosis improved after balloon dilation while another was probably related with bile reflux .Conclusions SMAS is prone to clinical misdiagnosis .Upper gastrointestinal angiography ,CT angiography and color Doppler ultrasonography are essential for making a definite diagnosis .Laparoscopic duodenojejunostomy is both safe and reliable for SM ACS and it is thus worthy of wider popularization .