肠系膜上动脉综合征 (2)精选PPT.ppt

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1、关于肠系膜上动脉综合征(2)第1页，讲稿共34张，创作于星期二第2页，讲稿共34张，创作于星期二第3页，讲稿共34张，创作于星期二第4页，讲稿共34张，创作于星期二Superior mesenteric artery syndrome 第5页，讲稿共34张，创作于星期二 superior mesenteric artery syndrome is a very rare,life-threatening gastrovascular disorder characterized by a compression of the third portion of the duodenum by t

2、he superior mesenteric artery.第6页，讲稿共34张，创作于星期二 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 th

3、e history of English-language medical literature,SMA syndrome is estimated to have a mortality rate of 1 in 3.第7页，讲稿共34张，创作于星期二 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

4、 of the left renal vein between the AA and the SMA.第8页，讲稿共34张，创作于星期二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 milli

5、meters,as opposed to the typical 10-20.第9页，讲稿共34张，创作于星期二 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

6、Syndrome can present in two forms:chronic/congenital or acute/induced.第10页，讲稿共34张，创作于星期二第11页，讲稿共34张，创作于星期二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12页，讲稿共34张，创作于星期二Predispos

7、ition easily aggravated such aspoor motility of the digestive tractretroperitional tumorscachexiaexaggerated lumbar lordosisvisceroptosisabdominal wall laxityperitoneal adhesionsabdominal trauma第13页，讲稿共34张，创作于星期二rapid linear adolescent growth spurt,weight lossstarvationcatabolic states(cancer and bu

8、rns).第14页，讲稿共34张，创作于星期二Symptomsearly satietynauseabilious vomitingextremestabbing postprandial abdominal pain(due to both the duodenal compression and the compensatory reversed peristalsis)severe malnutrition with spontaneous wasting.第15页，讲稿共34张，创作于星期二This,in turn,increases the duodenal compression

9、spurring a vicious cycle.Symptoms are partially relieved when in the left lateral,prone or knee-to-chest position.Symptoms are often aggravated when leaning to the right or taking a supine position.第16页，讲稿共34张，创作于星期二 Demographics SMA syndrome is extremely rare,evident in only 0.013-0.3%of uppergastr

10、ointestinal-tract barium studies.As the syndrome involves a lack of essential fat,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17页，讲稿共34张，创作于星期二Morta

11、lity SMA syndrome is estimated to have a mortality rate of 1 in 3.Delay in the diagnosis of SMA syndrome can result in:fatal malnutrition dehydration oliguria electrolyte abnormalities hypokalemia acute gastric rupture intestinal perforation(from prolonged mesenteric ischemia)gastrectasia第18页，讲稿共34张

12、，创作于星期二Diagnosis postprandial abdominal painnauseabilious vomitingwastingsymptoms relieved via the left lateral,prone or knee-to-chest positionupper gastrointestinal bariumabdominal and pelvic CT scan with contrast 第19页，讲稿共34张，创作于星期二 Upper gastrointestinal series showing extreme duodenal dilation(wh

13、ite arrow)abruptly preceding constriction by the SMA第20页，讲稿共34张，创作于星期二 Abdominal and pelvic CT scan showing duodenal compression(black arrow)by the abdominal aorta and the superior mesenteric artery.第21页，讲稿共34张，创作于星期二第22页，讲稿共34张，创作于星期二Treatment Conservative treatment should be attempted first,involv

14、ing the reversal or removal of the precipitating factor with proper nutrition and replacement of fluid and electrolytes.Pro-motility agents such as metoclopramide may also be beneficial.第23页，讲稿共34张，创作于星期二 If conservative treatment fails,or if the case is severe or chronic,surgical intervention is re

15、quired.The most common operation for SMA syndrome,duodenojejunostomy,was first proposed in 1907 by Bloodgood.第24页，讲稿共34张，创作于星期二 Less common surgical treatments for SMA syndrome include Roux-en-Y duodeno-jejunostomy,gastro-jejunostomy and lysis of the ligament of Treitz.第25页，讲稿共34张，创作于星期二 The worlds

16、first robotically-assisted intestinal bypass for SMA syndrome was performed on July 30,2008 at the London Health Sciences Centre in Ontario,Canada.第26页，讲稿共34张，创作于星期二第27页，讲稿共34张，创作于星期二第28页，讲稿共34张，创作于星期二第29页，讲稿共34张，创作于星期二第30页，讲稿共34张，创作于星期二第31页，讲稿共34张，创作于星期二第32页，讲稿共34张，创作于星期二第33页，讲稿共34张，创作于星期二感谢大家观看第34页，讲稿共34张，创作于星期二