In Patients with Celiac Artery Compression Syndrome, Does Surgery Improve Quality of Life?
In Patients with Celiac Artery Compression Syndrome, Does Surgery Improve Quality of Life?
复制标题
DOI：
10.1007/978-3-319-33293-2_22
复制
发表时间：
2017-01-01
期刊：
影响因子：
--
通讯作者：
Mak, Grace Zee
中科院分区：
文献类型：
--
作者：
Mak, Grace Zee
症状性腹腔动脉压迫是一个有争议的诊断，应考虑在患者慢性腹痛的病因不明，尽管广泛的医学评估。一旦怀疑，患者应进行肠系膜双功筛查。腹腔动脉流速升高，随呼吸恢复正常，随后CT血管造影显示腹腔动脉典型的“J钩”构型，从而确诊。然后，患者应接受多学科团队的评估，以适当选择患者进行手术治疗。手术选择包括正中弓状韧带松解术，伴或不伴腹腔神经丛松解术，伴或不伴血运重建术。方法可以是开放式、腹腔镜、机器人或腹膜后。手术治疗具有总体成功率，70-80%的患者报告腹痛和生活质量改善。术后，患者可能出现持续性或复发性腹痛，如果腹腔动脉恢复正常，则应重新评估是否可能需要进行腹腔动脉狭窄的血运重建术或腹腔神经丛阻滞。此外，这些患者中的一些将具有与功能性胃肠道疾病一致的持续性疼痛，然后需要医疗管理。
Symptomatic celiac artery compression is a controversial diagnosis that should be considered in patients with chronic abdominal pain of unknown etiology despite an extensive medical evaluation. Once suspected, patients should undergo screening mesenteric duplex. Diagnosis is confirmed with the findings of elevated celiac artery velocities which normalize with respiration followed by CT angiogram showing the typical "J-hook" conformation of the celiac artery. Patients should then undergo evaluation by a multi-disciplinary team to appropriately select patients for surgical treatment. Surgical options include release of the median arcuate ligament, with or without neurolysis of the celiac nerve plexus, and with or without concomitant revascularization procedures. Approaches can be open, laparoscopic, robotic, or retroperitoneal. Surgical treatment has an overall success rate with 70-80% patients reporting improved abdominal pain and quality of life. Post-operatively, patients can have persistent or recurrent abdominal pain and should undergo re-evaluation for possible need for revascularization procedure for stenosis of the celiac artery or celiac plexus block if the celiac artery is normalized. Additionally, some of these patients will have persistent pain consistent with a functional gastrointestinal disorder that will then require medical management.