Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector177810.17816/psaic1778Original Study ArticlesОригинальные исследованияResearch ArticleDiagnostics and surgical management children with superior mesenteric artery syndromeДиагностика и хирургическое лечение детей с артериомезентериальной компрессией двенадцатиперстной кишки儿童十二指肠动脉肠管受压迫的诊断和手术治疗https://orcid.org/0000-0003-3831-768X9674-1049SokolovYurii Yu.СоколовЮрий ЮрьевичSokolovYurii Yu.
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

MD, Dr. Sci. (Medicine), Professor

sokolov-surg@yandex.ruhttps://orcid.org/0000-0003-3614-64932124-5942GogichaevaAlaniia A.ГогичаеваАлания АлександровнаGogichaevaAlaniia A.
Russian Federation
gogichalani@gmail.comhttps://orcid.org/0000-0002-8030-99262091-6381KorovinSergey A.КоровинСергей АфанасьевичKorovinSergey A.
Russian Federation

MD, Dr. Sci. (Medicine)

д-р мед. наук

MD, Dr. Sci. (Medicine)

korovinsa@mail.ruhttps://orcid.org/0000-0002-5394-01656873-6732EfremenkovArtem M.ЕфременковАртем МихайловичEfremenkovArtem M.
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

MD, Cand. Sci. (Medicine)

efremart@yandex.ruhttps://orcid.org/0000-0002-5415-04999024-8324AkhmatovRoman A.АхматовРоман АнатольевичAkhmatovRoman A.
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

MD, Cand. Sci. (Medicine)

romaahmatov@yandex.ruRussian Medical Academy of Continuous Professional EducationРоссийская медицинская академия непрерывного профессионального образованияRussian Medical Academy of Continuous Professional EducationSt. Vladimir Children’s HospitalДетская городская клиническая больница святого ВладимираSt. Vladimir Children’s HospitalChildren Hospital of Z.A. BashlyaevaДетская городская клиническая больница им. З.А. БашляевойChildren Hospital of Z.A. Bashlyaeva160720241421831941801202423042024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-ВекторCopyright ©; 2024,2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/1778

BACKGROUND: Superior mesenteric artery syndrome causes chronic duodenal obstruction. Studies on this disease are limited; therefore, several difficulties in the diagnosis and treatment of such patients remain.

AIM: This study aimed to present the experience of treating children with superior mesenteric artery syndrome.

MATERIALS AND METHODS: The treatment results of 45 patients with superior mesenteric artery syndrome was retrospectively studied. The children complained of abdominal pain, nausea, occasional vomiting, belching, bloating, and constipation. The diagnosis was confirmed during a comprehensive examination, including ultrasound, esophagogastroduodenoscopy, X-ray contrast examination, computed tomography, and relaxation duodenography. Conservative therapy was performed in 38 (84,4%) children, and 21 (55,3%) children showed satisfactory results. In case of ineffectiveness of conservative measures (17 cases) or in a decompensated state (7 cases), indications for surgical treatment were provided.

Furthermore, 24 (53,3%) children underwent surgery. Duodenal drainage surgeries were performed in 20 (83,3%) patients with subcompensation of duodenostasis. Of these patients, 10 (41,7%) underwent lower duodenojejunostomy with a switched-off Roux-en-Y loop (Gregory–Smirnov’s operation) and the other 10 (41,7%) underwent anterior mesenteric duodenojejunostomy (Robinson’s operation). Laparotomic access was used in 14 cases (70,0%) and laparoscopic in 6 (30,0%) cases. Owing to decompensation of duodenostasis, the duodenum was excluded from passage by economical resection of the gastric outlet with gastrojejunostomy on a short loop with additional formation of a lower duodenojejunostomy according to Roux in 4 (16,7%) cases. Laparotomic access was used in all cases.

RESULTS: No intraoperative complications were noted. In the early postoperative period, two children developed anastomositis after Robinson’s operation and two patients after Gregory–Smirnov’s operation, which was treated with conservative measures. In long-term followup (up to 15 years), a satisfactory result was achieved in 87.5% of cases.

CONCLUSIONS: Superior mesenteric artery syndrome is a relatively rare cause of chronic duodenal obstruction in children. When selecting patients for surgical treatment, other diseases should be excluded. Surgical correction includes various options for duodenal drainage operations that can be successfully performed using laparoscopic access. In case of decompensation of duodenostasis, it may be crucial to exclude the duodenum from the passage.

Актуальность. Одна из причин хронической дуоденальной непроходимости — артериомезентериальная компрессия двенадцатиперстной кишки. Данное заболевание до сих пор изучено недостаточно, в связи с чем сохраняется ряд сложностей в диагностике и лечении таких больных.

Цель — представить результаты анализа лечения детей с артериомезентериальной компрессией двенадцатиперстной кишки.

Материалы и методы. Проведено ретроспективное исследование результатов лечения 45 пациентов с артериомезентериальной компрессией двенадцатиперстной кишки. Дети жаловались на боли в животе, тошноту, периодическую рвоту, отрыжку, вздутие живота и запоры. Диагноз был подтвержден при проведении комплексного обследования, включающего ультразвуковое исследование, эзофагогастродуоденоскопию, рентгеноконтрастное исследование, компьютерную томографию, релаксационную дуоденографию. Консервативная терапия проведена у 38 (84,4 %) детей, удовлетворительный результат достигнут у 21 (55,3%) ребенка. При неэффективности консервативных мероприятий (17 случаев) или при декомпенсированном состоянии (7 случаев) выставлены показания к оперативному лечению. Оперированы 24 (53,3 %) ребенка. При субкомпенсации дуоденостаза дренирующие двенадцатиперстную кишку операции выполнены 20 (83,3 %) пациентам. Из них нижний дуоденоеюноанастомоз с выключенной петлей по Ру (операция Грегори – Смирнова) выполнен 10 (41,7 %) детям, впередимезентериальный дуоденоеюноанастомоз (операция Робинсона) сформирован у 10 (41,7 %) детей. Лапаротомный доступ использован в 14 (70,0 %) случаях, а лапароскопический — в 6 (30,0 %). В связи с декомпенсацией дуоденостаза двенадцатиперстная кишка была выключена из пассажа путем резекции антрального отдела желудка с гастроэнтероанастомозом на короткой петле с дополнительным формированием нижнего дуоденоеюноанастомоза по Ру в 4 (16,7 %) наблюдениях. Во всех случаях использовали лапаротомный доступ.

Результаты. Итраоперационных осложнений не было. В раннем послеоперационном периоде у 2 детей после операции Робинсона и у 2 пациентов после операции Грегори – Смирнова развились явления анастомозита, которые купированы консервативными мероприятиями. В отдаленные сроки наблюдения (до 15 лет) удовлетворительный результат достигнут в 87,5 % случаев.

Заключение. Артериомезентериальная компрессия двенадцатиперстной кишки является относительно редкой причиной хронической дуоденальной непроходимости. При отборе пациентов на оперативное лечение необходимо исключить другие заболевания. Хирургическая коррекция включает различные варианты дренирующих двенадцатиперстную кишку операций, которые могут быть успешно выполнены при использовании лапароскопического доступа. При декомпенсации дуоденостаза может потребоваться выключение двенадцатиперстной кишки из пассажа.

现实意义。慢性十二指肠梗阻的原因之一是十二指肠动脉肠管受压迫。人们对这种疾病的了解还很有限，因此在诊断和治疗这类患者时仍存在许多困难。本研究旨在介绍儿童十二指肠动脉肠管受压迫的治疗分析结果。

材料与方法。我们对45名十二指肠动脉肠管受压迫患者的治疗结果进行了回顾性研究。患儿主诉腹痛、恶心、周期性呕吐、打嗝、腹胀和便秘。通过超声波、食管胃十二指肠镜、X光造影、计算机断层扫描和舒张十二指肠造影等全面检查确诊。38名患儿（84.4%）接受了保守治疗，21名患儿（55.3%） 取得了满意的疗效。当保守治疗无效（17例）或失代偿状态（7例）时，就需要进行手术治疗。24例（53.3%）患儿接受了手术治疗。在十二指肠淤滞的失代偿治疗中，20名（83.3%）患者接受了十二指肠引流手术。其中，10例（41.7%）患儿进行了下十二指肠空肠吻合术（Roux环）（Gregory-Smirnov手术），10例（41.7%）患儿进行了肠前十二指肠空肠吻合术（Robinson手术）。14例（70.0%）采用了腹腔镜手术，6例（30.0%）采用了腹腔镜手术。有4例（16.7%）患者因十二指肠淤滞失代偿，通过切除胃的前部，在短襻上淤滞胃肠吻合术，并根据鲁氏（Roux）术式行十二指肠空肠下端吻合术，将十二指肠从通道中排除。所有病例均采用腹腔镜手术入路。

结果。术中没有出现并发症。术后早期，2名接受Robinson手术的患儿和2名接受 Gregory-Smirnov手术的患者出现了吻合口炎，经保守治疗后好转。在长期随访（长达15年）中，87.5%的病例取得了令人满意的结果。

结论。十二指肠动脉肠管受压迫是慢性十二指肠梗阻相对少见的的病因。在选择接受手术治疗的患者时，必须排除其他疾病。手术矫正包括十二指肠引流手术的各种变体，可通过腹腔镜入路成功实施。在十二指肠淤滞失代偿的情况下，可能需要断开十二指肠通道。

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