Objective To compare efficacy of laparoscopic and open duodenal circular drainage operation for superior mesenteric artery compressing syndrome (SMACS). Methods From December 2012 to December 2015, the clinical data of 23 cases of laparoscopic duodenal circular drainage operation (laparoscope group) and 28 cases of open duodenal circular drainage operation (open group) were analyzed. The operation time, intraoperative bleeding, postoperative ambulation time, postoperative analgesics usage, postoperative the first exhaust time, postoperative the first feeding time, postoperative hospitalization time and postoperative incidence of complications were compared. The patients were followed up to confirm the effect after the operation. Results There were no differences of the age, sex, and body weight index between the laparoscope group and the open group (P>0.05). The operation time had no significant difference between these two groups (P>0.05). Compared with the open group, the intraoperative bleeding was less (P<0.05), the postoperative ambulation time, postoperative the first exhaust time, postoperative the first feeding time, postoperative hospitalization time were shorter (P<0.05), the rates of postoperative analgesics usage, incision infection, pulmonary infection, and intestinal obstruction were lower (P<0.05) in the laparoscope group. The rates of anastomotic leakage and anastomotic bleeding, and total postoperative complications rate had no significant differences between these two groups (P>0.05). All the patients were followed up for 8–36 months. The clinical symptoms disappeared and the body weight increased to normal level in the two groups. Conclusions Preliminary results of in this study show that laparoscopic duodenal circular drainage operation in treatment of SMACS has some advantages such as less trauma, faster recovery, fewer complications and shorter hospitalization time. Laparoscopy will be an ideal choice for treatment of SMACS.
Objective To evaluate the clinical efficacy and safety of endovascular therapy for spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods The clinical data of 17 patients with SISMAD, who were treated at author's hospital during the period from March 2009 to May 2016, were retrospectively analyzed. According to the Sakamoto angiographic classification, patients were divided into typeⅠ (n=3), typeⅡ (n=5), and type Ⅲ (n=9). Three patients with type Ⅰ were treated with conservative treatment first, and then 2 were treated with endovascular therapy as the poor reaction. The other patients were treated with endovascular treatment right a way. Results Conservative treatment was success in 1 case, 16 patients were treated with endovascular treatment, the technical success rate was 100%, one stent was used in 11 patients and two stents were used in 5 patients, and the blood in the true lumen of superior mesenteric artery (SMA) restored, no major complications occurred. Seventeen patients were followed-up for 3-36 months (mean of 19 months) and the followed-up rate was 100%, no abdominal pain occurred in 17 cases, CTA showed that no dissecting aneurysm was observed and the stents were patent of SMA. Conclusion Interventional therapy is a safe and effective method for SISMAD.
ObjectiveTo explore the feasibility and safety of modified semi-ex vivo small intestinal autotransplantation (IAT) in patients with distal cholangiocarcinoma (CC) involving mesenteric root. MethodThe clinicopathologic data of the patient with relapse after CC surgery admitted to Sichuan Provincial People’s Hospital on October 2022 were retrospectively analyzed. ResultsThe patient was a 40 years old male. The preoperative imaging showed that the superior mesenteric artery (SMA) and jejunal artery was surrounded by the tumor. The preoperative condition was good and the heart, lung, liver, and kidney functions were normal. The patient could tolerate surgery, then the modified semi-ex vivo IAT was performed. The patient recovered well after surgery and discharged on the 14th postoperative day. The postoperative pathological diagnosis result showed that it was CC. The patient was well and without recurrence or metastasis during following-up in the outpatient service for 5 months until April 2023. ConclusionsFrom the retrospective analysis of this case, it can be realized that the modified semi-ex vivo IAT for patients with tumor involving themesenteric root, it is safe and feasible. A treatment option can be provided for such patient.
ObjectiveTo explore the current research status of endovascular treatment for isolated superior mesenteric artery dissection (ISMAD) so as to provide a reference for vascular surgeons and patients in selecting treatment methods. MethodThe recent domestic and international literature on the endovascular treatment for ISMAD was collected and summarized. ResultsThe current endovascular treatment methods for ISMAD mainly included catheter-directed thrombolysis and stent placement. For the ISMAD patients with true intraluminal thrombus formation, true luminal occlusion, and partial embolization of branch vessels, the catheter-directed thrombolysis was performed by continuously pumping urokinase locally to dissolve thrombus and improve distal blood supply. The stent placement mainly included two main types: bare stent placement and covered stent placement, both aiming to promote true lumen recanalization, false lumen thrombosis, and vascular remodeling through mechanical support and blood flow redirection. The bare stents had unique advantages such as being well-developed, offering a wide range of options, and having stable performance. However, covered stents were superior to bare stents in terms of mid-term patency rate and in-stent restenosis. ConclusionsWith the development of technology, endovascular treatment has become an indispensable method for ISMAD patients. Extensive multicenter cases reports from both domestic and international studies have supported the safety and efficacy of endovascular treatment. Catheter-directed thrombolysis and stent placement (bare stent and covered stent) offer targeted solutions for various types of ISMAD patients, providing more minimally invasive and effective treatment.