СРАВНИТЕЛЬНАЯ ХАРАКТЕРИСТИКА И РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ БОЛЬНЫХ СИНДРОМОМ КОМПРЕССИИ ЧРЕВНОГО СТВОЛА И В СОЧЕТАНИИ С РЕФЛЮКС-ЭЗОФАГИТОМ

Relevance. Clarifying the sequence and mutual connection of the median arcuate ligamentum syndrome (MALS) and reflux esophagitis (RE) makes it possible to determine the indications and success of the operation. The objective of the study was to compare the results of the examination and operations in patients with the MALS in combination with RE. Material and methods. 198 patients with MALS were examined and operated. Among them, 85 patients was just with MALS, and decompression of celiac trunk was performed for them. 84 patients had MALS and RE, simultaneously decompression of celiac trunk and Nissen fundoplication were performed for that group of patients. 29 patients had MALS and RE, only decompression of celiac trunk was performed for that group. A comparative analysis of the results of examination and surgical treatment of 85 patients with the MALS and 84 in combination with RE was carried out. The average age of the patients is about 30 years, the female gender prevailed. The feeling of heaviness and abdominal pain due to eating and physical activity, neurovegetative disorders was almost in all patients. Daily or weekly heartburn, regurgitation, vomiting and dysphagia as well as edema, erythema and erosion of the esophageal mucosa were observed mainly in patients with MALS in combination with ER. Results. Significant compression stenosis of the celiac trunk was detected in all patients. After the decompression of the celiac trunk in patients with MALS as well as decompression of the celiac trunk and Nissen fundoplication in patients with MALS in combination with ER, most of them received good clinical results and normalization of anatomical and hemodynamic parameters in celiac trunk. Conclusion. In the combined version of the MALS and RE and the corresponding indications it is expedient to perform decompression of celiac trunk and Nissen fundoplication simultaneously.Введение. Выяснение последовательности и взаимной связи синдрома компрессии чревного ствола и рефлюкс- эзофагита дает возможность определить показания и успех операции. Цель исследования – сравнить результаты обследования и операций у больных синдромом компрессии чревного ствола и в сочетании с рефлюкс-эзофагитом. Материал и методы. Были обследованы и оперированы 198 больных с синдромом компрессии чревного ствола (СКЧС). Из них у 85 был только СКЧС, им произведена декомпрессия чревного ствола (ДЧС). У 84 был СКЧС и рефлюкс-эзофагит (РЭ), им выполнена одновременна ДЧС и фундопликация по Ниссену. У 29 был СКЧС и РЭ, им сделана только ДЧС. У всех больных оценены исходы операций. Проведен сравнительный анализ данных обследования и хирургического лечения 85 больных СКЧС и 84 в сочетании с РЭ. Средний возраст больных – около 30 лет, превалировали лица женского пола. Ощущение тяжести и боль в животе в связи с приемом пищи и физической нагрузкой, нейровегетативные расстройства были почти у всех больных. Ежедневная или еженедельная изжога, срыгивание, рвота и дисфагия, а также отек, эритема и эрозии слизистой пищевода наблюдались в основном у больных СКЧС с РЭ. Результаты исследования. У всех больных выявлен значимый компрессионный стеноз чревного ствола. После ДЧС у больных СКЧС, а также ДЧС и фундопликации по Ниссену у больных СКЧС с РЭ у большей части из них были получены хорошие клинические результаты, нормализация анатомических и гемодинамических показателей в ЧС. Заключение. При сочетанном варианте СКЧС и РЭ и соответствующих показаниях целесообразно выполнение одновременно ДЧС и ФП по Ниссену

Repeated operations in patients with unsatisfactory results of celiac artery compression syndrome treatment

Purpose of the study. The reasons for the unsatisfactory results of surgical treatment of patients with celiac artery compression syndrome (CACS) and the role of repeated interventions allows to achieve a lasting improvement in most of them. The purpose of the study is to clarify the reasons for the unsatisfactory outcomes of surgical treatment of patients with CACS and the nature and significance of repeated operations.Patients and methods. From 860 patients with CASC who were operated on over the past 25 years 82 patients were selected with unsatisfactory treatment results. Initial conventional abdominal surgery was performed in 26 (31.7%) patients without a positive outcome before decompression of celiac artery (DCA). Primary operations were performed in 82 patients with proven CASC, of which 69 (84.1%) had DCA in open approach, isolated in 43 (52.4%) and combined in 26 (31.7%). Embolization of PDA aneurysm in one (1.2%) patient. In other medical institutions 15 (18.3%) patients were operated, among them 3 (3.7%) patients had DCA in open approach, in 4 (4.9%) laparoscopic DCA, in 6 (7.3%) angioplasty and emergency stenting and two (2.4%) reconstructive operations, all technically and clinically unsuccessful.Results. After DCA in open approach 51 (73.9%) patients of 69 patients had normal celiac artery flow. 4 patients had unresolved stenosis of the celiac artery and 15 relapsed its stenosis, one of them with residual stenosis after DCA twice, which amounted to 0.5% and 1.7%, respectively of 860 patients. Repeated operations were performed in 51 (62.2%) patients out of 82 to restore the celiac artery in 28 (34.2%), among them 4 (4.9%) in combination with interventions on the abdominal organs. Abdominal operations with concomitant diseases of the gastrointestinal tract with normal flow in celiac artery in 21 (25.6%).Scalenotomy in two (2.4%). Of 28 patients, re-revascularization of the celiac artery was successful as a result of open decompression in 7 out of 8, bypass surgery in 9 out of 10 and balloon angioplasty and with stenting in two out of 7. One had an effective primary DCA and the other resected PDA aneurysm. 19 patients out of 25 showed a good result after operations on the abdominal organs.Conclusion. The unsatisfactory results of surgical treatment of patients with CASC are associated with inadequate restoration of celiac artery restenosis and/or concomitant diseases of the abdominal organs. Repeated vascular operations are mainly: decompression of celiac artery in open approach, bypass surgery and balloon angioplasty and stenting, and/or abdominal mainly: cholecystectomy, NissenFP, and Strong surgery are of primary importance in the treatment of patients with CASC