正中弓状靱帯圧迫症候群：50症例の患者背景・術式による比較検討

Comparative study of patient background and surgical techniques in 50 cases of median arcuate ligament syndrome

◆要旨：正中弓状靱帯圧迫症候群（以下，MALS）は，正中弓状靱帯により腹腔動脈（以下，CA）や腹腔神経叢・神経節が圧迫され，食後の腹痛や内臓動脈瘤をきたす疾患である．MALSに対して内視鏡外科手術を行った50例を有症状群と動脈瘤群，腹腔鏡下アプローチ群と後腹膜アプローチ群に分け，後方視的に比較検討した．動脈瘤群は有症状群と比較し，高齢・男性・側副血行路が発達している症例に多かった（P＜0.05）．後腹膜アプローチ群は腹腔鏡下アプローチ群と比較し，手術時間が短く，CA起始部の高さにかかわらず手術時間が安定しており，術後下痢の発生率が低かった（P＜0.05）．症状改善率は96.0％で，手術方法による差を認めなかった．MALSの病態・手術方法について報告する．

　Median arcuate ligament syndrome（MALS） is a condition characterized by the compression of the celiac artery, celiac plexus, and ganglia by the median arcuate ligament, resulting in postprandial abdominal pain and visceral artery aneurysms. In this study, we retrospectively analyzed 50 cases of MALS that underwent minimally invasive surgery. The cases were divided into symptomatic and aneurysm groups, as well as laparoscopic and retroperitoneal approach groups, and a comparative examination was conducted. The aneurysm group showed a higher prevalence of elderly male patients and cases with well-developed collateral blood vessels compared to the symptomatic group（P＜0.05）. The retroperitoneal approach demonstrated a shorter operative time and consistent operative time regardless of the height of the celiac artery origin, as compared to the intraperitoneal approach. Additionally, the retroperitoneal approach resulted in a lower incidence of postoperative diarrhea（P＜0.05）. The overall symptom improvement rate was 96.0％, with no significant differences observed among the surgical approaches. This study provides a comprehensive report on the pathophysiology of MALS and the surgical approaches employed for its treatment.