肠系膜上动脉综合征 (2)讲稿.ppt

《肠系膜上动脉综合征 (2)讲稿.ppt》由会员分享，可在线阅读，更多相关《肠系膜上动脉综合征 (2)讲稿.ppt（34页珍藏版）》请在得力文库 - 分享文档赚钱的网站上搜索。

1、关于肠系膜上动脉综合征(2)第一页，讲稿共三十四页哦第二页，讲稿共三十四页哦第三页，讲稿共三十四页哦第四页，讲稿共三十四页哦Superior mesenteric artery syndrome 第五页，讲稿共三十四页哦 superior mesenteric artery syndrome is a very rare,life-threatening gastrovascular disorder characterized by a compression of the third portion of the duodenum by the superior mesenteric ar

2、tery.第六页，讲稿共三十四页哦 SMA syndrome was first described in 1861 by Carl Freiherr von Rokitansky in victims at autopsy,but remained pathologically undefined until 1927 when Wilkie published the first comprehensive series of 75 patients.With only about 500 reported cases in the history of English-language

3、medical literature,SMA syndrome is estimated to have a mortality rate of 1 in 3.第七页，讲稿共三十四页哦 SMA syndrome is also known as Wilkies syndrome,cast syndrome,mesenteric root syndrome,chronic duodenal ileus It is distinct from Nutcracker syndrome,which is the entrapment of the left renal vein between the

4、 AA and the SMA.第八页，讲稿共三十四页哦causes The syndrome is typically caused by an angle of 6-25between the AA and the SMA,in comparison to the normal range of 38-56due to a lack of retroperitoneal and visceral fat.In addition,the aorto-mesenteric distance is 2-8 millimeters,as opposed to the typical 10-20.第

5、九页，讲稿共三十四页哦 Retroperitoneal fat and lymphatic tissue normally serve as a cushion for the duodenum,protecting it from compression by the SMA.SMA syndrome is thus triggered by any condition involving an insubstantial cushion and narrow mesenteric angle.SMA Syndrome can present in two forms:chronic/con

6、genital or acute/induced.第十页，讲稿共三十四页哦第十一页，讲稿共三十四页哦Risk anatomic factors such as:very thin or lanky body build,an unusually high insertion of the duodenum at the ligament of Treitz,a particularly low origin of the SMA.第十二页，讲稿共三十四页哦Predisposition easily aggravated such aspoor motility of the digestive

7、 tractretroperitional tumorscachexiaexaggerated lumbar lordosisvisceroptosisabdominal wall laxityperitoneal adhesionsabdominal trauma第十三页，讲稿共三十四页哦rapid linear adolescent growth spurt,weight lossstarvationcatabolic states(cancer and burns).第十四页，讲稿共三十四页哦Symptomsearly satietynauseabilious vomitingextre

8、mestabbing postprandial abdominal pain(due to both the duodenal compression and the compensatory reversed peristalsis)severe malnutrition with spontaneous wasting.第十五页，讲稿共三十四页哦This,in turn,increases the duodenal compression spurring a vicious cycle.Symptoms are partially relieved when in the left la

9、teral,prone or knee-to-chest position.Symptoms are often aggravated when leaning to the right or taking a supine position.第十六页，讲稿共三十四页哦 Demographics SMA syndrome is extremely rare,evident in only 0.013-0.3%of uppergastrointestinal-tract barium studies.As the syndrome involves a lack of essential fat

10、,four of every five afflicted are underweight,often to the point of sickliness and emaciation.Females are impacted twice as often as males,with 75%of cases occurring between the ages of 10 and 30.第十七页，讲稿共三十四页哦Mortality SMA syndrome is estimated to have a mortality rate of 1 in 3.Delay in the diagnos

11、is of SMA syndrome can result in:fatal malnutrition dehydration oliguria electrolyte abnormalities hypokalemia acute gastric rupture intestinal perforation(from prolonged mesenteric ischemia)gastrectasia第十八页，讲稿共三十四页哦Diagnosis postprandial abdominal painnauseabilious vomitingwastingsymptoms relieved

12、via the left lateral,prone or knee-to-chest positionupper gastrointestinal bariumabdominal and pelvic CT scan with contrast 第十九页，讲稿共三十四页哦 Upper gastrointestinal series showing extreme duodenal dilation(white arrow)abruptly preceding constriction by the SMA第二十页，讲稿共三十四页哦 Abdominal and pelvic CT scan s

13、howing duodenal compression(black arrow)by the abdominal aorta and the superior mesenteric artery.第二十一页，讲稿共三十四页哦第二十二页，讲稿共三十四页哦Treatment Conservative treatment should be attempted first,involving the reversal or removal of the precipitating factor with proper nutrition and replacement of fluid and el

14、ectrolytes.Pro-motility agents such as metoclopramide may also be beneficial.第二十三页，讲稿共三十四页哦 If conservative treatment fails,or if the case is severe or chronic,surgical intervention is required.The most common operation for SMA syndrome,duodenojejunostomy,was first proposed in 1907 by Bloodgood.第二十四

15、页，讲稿共三十四页哦 Less common surgical treatments for SMA syndrome include Roux-en-Y duodeno-jejunostomy,gastro-jejunostomy and lysis of the ligament of Treitz.第二十五页，讲稿共三十四页哦 The worlds first robotically-assisted intestinal bypass for SMA syndrome was performed on July 30,2008 at the London Health Sciences Centre in Ontario,Canada.第二十六页，讲稿共三十四页哦第二十七页，讲稿共三十四页哦第二十八页，讲稿共三十四页哦第二十九页，讲稿共三十四页哦第三十页，讲稿共三十四页哦第三十一页，讲稿共三十四页哦第三十二页，讲稿共三十四页哦第三十三页，讲稿共三十四页哦感感谢谢大大家家观观看看第三十四页，讲稿共三十四页哦