ABSTRACT
Median arcuate ligament syndrome(MALS)is compression of the celiac trunk by the median arcuate ligament.Median arcuate ligament release is the corner stone for the surgical treatment of MALS.Open surgery,laparoscopic surgery,and robot-assisted surgery have been developed,among which laparoscopic surgery has been proposed as the preferred approach in view of its minimal trauma and short hospital stay.Auxiliary celiac plexus neurolysis could further alleviate the patient's discomfort.Moreover,vascular reconstitution is of vital importance in the case of persistent stenosis in the celiac artery despite of median arcuate ligament decompression.Vascular reconstruction has satisfactory long-term patency rate,while endovascular treatment is less invasive.This article aims to summarize the consensuses and advances and shed light on the surgical treatment of MALS.
Subject(s)
Humans , Celiac Artery/surgery , Constriction, Pathologic/surgery , Decompression, Surgical , Laparoscopy , Ligaments/surgery , Median Arcuate Ligament Syndrome/surgeryABSTRACT
Objective To analyze the clinical value of percutaneous transhepatic biliary drainage (PTBD) in the treatment of obstructive jaundice.Methods A total of 479 patients with obstructive jaundice were enrolled in PLA General Hospital from July 2015 to July 2017 underwent percutaneous transhepatic biliary drainage,the preoperative serum total bilirubin was 92 ～ 614 μmol/L,the target bile duct was 2 ～ 16 mm in diameter.The PTBD was ultrasound guided.Results All of the 479 patients underwent PTBD successfully,and 99.6％ showed evident alleviation of jaundice postoperatively.Conclusions Ultrasoundguided PTBD is an effective method for reducing jaundice for preoperative or palliative treatment in patients with obstructive jaundice.The method of operation is worthy of further study.