Úvod: Kompresia truncus coeliacus je jednou z pričin vzniku chronickej abdominalnej ischemie. Autori popisuju svoje skusenosti s chirurgickou liečbou Dunbarovho syndromu u 12 pacientov. Cieľom članku bola retrospektivna analyza chirurgickej liečby kompresie truncus coeliacus. Metóda: V obdobi rokov od 2007 do 2016 sme liečili 12 pacientov pre kompresivny syndrom truncus coeliacus. V ramci diagnostiky bolo každemu pacientovi realizovane USG vyšetrenie brucha, CT angiografia alebo DSA. Metodou voľby u tychto pacientov bola chirurgicka liečba. Štyrom pacientom sme resekovali vlakna ligamentum arcuatum mediale diafragmy a nervove vlakna plexus coeliacus. U 8 pacientov sme museli resekovať fibroticky zmeneny stenoticky až uzavrety truncus coeliacus. Ako rekonštrukciu sme vykonali aorto-trunkalny proteticky alebo venozny bypass, interpozitum alebo patch -plastiku. Výsledky: V pooperačnom obdobi sa nevyskytli zavažne komplikacie, ani umrtia. U jedneho pacienta v pooperačnom obdobi pretrvavaju klinicke priznaky chronickej abdominalnej ischemie. Záver: Chirurgicka liečba je metodou voľby pri kompresii truncus coeliacus. Indikaciou na chirurgicku rekonštrukciu su symptomaticki pacienti so stenozou arterie viac ako 50 %. Spravna diagnostika a včasna chirurgicka liečba ma vyznam pre liečbu chronickej visceralnej ischemie a zniženie počtu z toho rezultujucich chirurgickych komplikacii.

Introduction: Celiac axis compression syndrome is one of the causes of chronic abdominal ischemia. The authors describe their experience with the surgical treatment of Dunbar syndrome in 12 patients. The purpose of the authors was a retrospective analysis of the surgical treatment of celiac axis compression syndrome. Method: Between 2007 and 2016, we treated 12 patients for the celiac axis compressive syndrome. Each patient has performed abdominal sonography, CT-angiography, or angiography. The method of choice in these patients was surgical treatment. In 4 patients we resected median arcuate ligament and nerve fibers of celiac axis. In 8 patients we had to resect the stenotic or occluded celiac axis. We reconstructed the blood supply to the celiac axis by the aorto-celiac bypass, using prothetic or venous grafting or patch plastic of celiac axis stenosis. Results: There were no significant complications and deaths in the post - operative period. In one patient signs of chronic abdominal ischemia postoperatively persist. Conclusion: Surgery is the method of choice of celiac axis compression syndrome. Indications for surgical reconstruction are symptomatic patients with arterial stenosis over 50%. Proper diagnosis and early surgical treatment are essential for treating chronic visceral ischemia and reducing surgical complications.

Klinika cievnej chirurgie VÚSCH a s a Lekárska fakulta Univerzita Pavla Jozefa Šafárika v Košiciach

Szív Ér és Mellkas sebészeti Osztály HM Egészségügyi Központ Budapest

Celiac axis compression syndrome – diagnostic and surgical treatment