• 四川大學華西醫(yī)院泌尿外科,四川成都 610041;

摘要:目的:探討胡桃夾綜合征(NCS)在成年患者中的臨床表現(xiàn)、診斷及治療特點。方法:回顧性分析四川大學華西醫(yī)院泌尿外科2001年2月至2008年11月期間收治入院的21例胡桃夾綜合征患者的臨床病歷資料。結果:21例患者男性15例,女性6例。以血尿為最主要的癥狀,其中19例(9048%)為肉眼血尿,2例(952%)為顯微鏡下血尿。17例(8095%)患者尿中正常形態(tài)紅細胞≥85%,11例(5238%)患者尿蛋白呈陽性,9例(4286%)患者彩超發(fā)現(xiàn)平臥位左腎靜脈最寬處內徑(a)與最窄處內徑(b)比值均數(shù)為45±24,直立位a/b均數(shù)為81±26。15例(7143%)患者CT呈現(xiàn)左腎靜脈受壓表現(xiàn),8例(3809%)患者膀胱鏡檢見左側輸尿管口噴血。7例(3333%)行左腎靜脈下移—下腔靜脈端側吻合術,平均血管阻斷時間23±554min,血尿、蛋白尿在術后消失,其余14例(6667%)行保守治療,獲得隨訪的5例患者中有3例血尿消失,2例患者仍有無癥狀性血尿和蛋白尿。結論:尿紅細胞形態(tài)、腎血管彩色超聲、增強CT、核磁共振(MRI)及膀胱鏡檢查對胡桃夾綜合征的診斷具有重要價值,左腎靜脈下移—下腔靜脈端側吻合術治療胡桃夾綜合征效果明確,術后并發(fā)癥少。 關鍵詞:胡桃夾綜合征;左腎靜脈;血尿

引用本文： 王峰,朱育春,盧一平,曾浩,楊宇如. 21例成年人胡桃夾綜合征臨床診治分析. 華西醫(yī)學, 2009, 24(5): 1103-1105. doi: 復制

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4. MARKUS H, GANLUCA D, CHRISTIAN H, et al. Transposition of left renal vein for treatment of the nutcracker syndrome in longterm followup[J]. Urology,2002,59:354357.
5. TAKEBAYASHI S, UEKI T, IKEDA N, et al. Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with ?ow patterns on retrograde left renal venography[J]. Am J Roentgenol,1999,172:3943.
6. ZHANG H, LI M, JIN W, et al. The left renal entrapment syndrome: diagnosis and treatment[J]. Ann Vasc Surg,2007,21:198203.
7. SHIN J I, PARK J M, LEE S M. Factor affecting spontaneous resolution of hematuria in childhood nutcracker syndrome[J]. Pediatr Nephrol,2005,20(5):609613.
8. GONGY, SONG B. The nutcracker syndrome[J]. Urol,2003,169(6):22932294.
9. Segawa N, Azuma H, Wamoto Y, et al. Expandable metallic stent placement for nutcracker phenomenon[J]. Urology,1999,53(3):633.
10. SHOKEIR A, EIDIASTY T, GHONEIM M. The nutcracker syndrome: new methods of diagnosis and treatment[J]. Br J Urol,1994,74:139143.
11. HOHENFELLNER M, D ELIA G, HAMPLE C, et al. Transposition of the left renal vein for treatment of the nutcracker phenomenon: longterm followup[J]. Urology,2002,59:354357.
  1. 1. ANDRIANNE R, LIMET R, et al. Hematuria casused by nutcracker syndrome preoperative confirmation of its presence[J]. Prog Urol,2002,12(6):13231236.
  2. 2. SCULTETUS A H, VILLAVICENCIO J L, et al. The nutcracker syndrome: its role in the pelvic venous disorders[J]. J Vasc Surg,2001,34(5):812819.
  3. 3. VEHASKARI V M. Mechanism of orthostatic proteinuria[J]. Pediatr Nephrol,1990,4(4):328330.
  4. 4. MARKUS H, GANLUCA D, CHRISTIAN H, et al. Transposition of left renal vein for treatment of the nutcracker syndrome in longterm followup[J]. Urology,2002,59:354357.
  5. 5. TAKEBAYASHI S, UEKI T, IKEDA N, et al. Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with ?ow patterns on retrograde left renal venography[J]. Am J Roentgenol,1999,172:3943.
  6. 6. ZHANG H, LI M, JIN W, et al. The left renal entrapment syndrome: diagnosis and treatment[J]. Ann Vasc Surg,2007,21:198203.
  7. 7. SHIN J I, PARK J M, LEE S M. Factor affecting spontaneous resolution of hematuria in childhood nutcracker syndrome[J]. Pediatr Nephrol,2005,20(5):609613.
  8. 8. GONGY, SONG B. The nutcracker syndrome[J]. Urol,2003,169(6):22932294.
  9. 9. Segawa N, Azuma H, Wamoto Y, et al. Expandable metallic stent placement for nutcracker phenomenon[J]. Urology,1999,53(3):633.
  10. 10. SHOKEIR A, EIDIASTY T, GHONEIM M. The nutcracker syndrome: new methods of diagnosis and treatment[J]. Br J Urol,1994,74:139143.
  11. 11. HOHENFELLNER M, D ELIA G, HAMPLE C, et al. Transposition of the left renal vein for treatment of the nutcracker phenomenon: longterm followup[J]. Urology,2002,59:354357.