BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of ...BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.展开更多
孤立性肠系膜上动脉夹层(isolated dissection of the superior mesenteric artery,IDSMA)曾被认为是一种罕见病。近年来,随着增强CT的广泛应用,越来越多的IDSMA被报道,其中来自于中国的病例数量最多。本文对国内报道的IDSMA的临床数据...孤立性肠系膜上动脉夹层(isolated dissection of the superior mesenteric artery,IDSMA)曾被认为是一种罕见病。近年来,随着增强CT的广泛应用,越来越多的IDSMA被报道,其中来自于中国的病例数量最多。本文对国内报道的IDSMA的临床数据进行汇总、分析,并将部分数据与国外数据进行对比,以期反映国内诊治IDSMA的临床现状。展开更多
目的:分析国人特发性收缩性肠系膜炎的临床特点,提高对该病的认识,避免误诊误治．方法:回顾性分析我院确诊的3例和近28 a 来国内期刊发表的33篇文献报道44例总共47 例特发性收缩性肠系膜炎的临床资料,总结其在发病年龄、性别、诱因、临...目的:分析国人特发性收缩性肠系膜炎的临床特点,提高对该病的认识,避免误诊误治．方法:回顾性分析我院确诊的3例和近28 a 来国内期刊发表的33篇文献报道44例总共47 例特发性收缩性肠系膜炎的临床资料,总结其在发病年龄、性别、诱因、临床表现、诊治、病变部位大小、预后等方面的特点．结果:特发性收缩性肠系膜炎好发于中老年, 男女比例相当．以腹痛和腹部肿物为主要表现,病变长径多>5 cm,以小肠系膜多见,其次是盲肠升结肠系膜,横结肠、降结肠、乙状结肠系膜和大网膜少见．结论:特发性收缩性肠系膜炎缺乏特异性的临床和影像学表现,极易被误诊．确诊主要依赖手术探查和病理检查．本病的预后好．临床上提高对该病的认识和病理检查是提高确诊率的关键．展开更多
文摘BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.
文摘孤立性肠系膜上动脉夹层(isolated dissection of the superior mesenteric artery,IDSMA)曾被认为是一种罕见病。近年来,随着增强CT的广泛应用,越来越多的IDSMA被报道,其中来自于中国的病例数量最多。本文对国内报道的IDSMA的临床数据进行汇总、分析,并将部分数据与国外数据进行对比,以期反映国内诊治IDSMA的临床现状。
