Value of Mulit-Slice CT in Diagnosing Nutcracker Phenomenon_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 董志伟 , 高博 , 赵欣

保定市第三医院/肿瘤医院放射科（河北保定 071000）;

Corresponding author：

董志伟, Email: dongzhi79@sohu.com

Keywords：

肠系膜上动脉; 胡桃夹现象; X线计算机，断层摄影术

DOI：

10.7507/1007-9424.20140126

Video：

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目的探讨多排螺旋CT（MSCT）诊断胡桃夹现象的价值及临床意义。方法对40例正常者（对照组）和12例胡桃夹现象患者（病例组）的腹部MSCT动脉期及延迟期图像进行后处理，测量腹主动脉与肠系膜上动脉（SMA）的夹角、左肾静脉层面腹主动脉前壁与SMA后壁的距离以及左肾静脉最小前后径，并观测左侧精索或卵巢静脉或左侧腰静脉是否扩张。结果对照组及病例组所有观察对象MSCT均清晰显示左肾静脉、SMA及腹主动脉之间的立体解剖关系。对照组中无一例出现左肾静脉近段及左侧精索静脉或卵巢静脉或左侧腰静脉扩张；腹主动脉与SMA的平均夹角为71.4°，左肾静脉层面腹主动脉前壁与SMA后壁的平均距离为13.7 mm，左肾静脉平均最小前后径为6.9 mm。病例组中左肾静脉近段及左侧精索静脉或卵巢静脉扩张12例，左侧腰静脉扩张5例；腹主动脉与SMA的平均夹角为27.4°，左肾静脉层面腹主动脉前壁与SMA后壁的平均距离为3.8 mm，左肾静脉平均最小前后径为2.7 mm，近端肾静脉扩张。经两独立样本均数t检验，病例组腹主动脉与SMA的夹角、左肾静脉层面腹主动脉前壁与SMA后壁的距离及左肾静脉最小前后径均明显小于对照组（P＜0.05）。结论 MSCT可清晰显示SMA、腹主动脉和左肾静脉之间的解剖关系，对诊断胡桃夹现象具有很高的价值。

Citation： 董志伟, 高博, 赵欣. Value of Mulit-Slice CT in Diagnosing Nutcracker Phenomenon. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(4): 516-518. doi: 10.7507/1007-9424.20140126 Copy

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2.	Cheen JE, Kim WS, Kim IO, et al. Nutcracker syndrome in children with gross hematuria:Doppler sonographic evaluation of the left renal vein[J]. Pediatr Raidiol, 2006, 36(7):682-686.
3.	De Schepper A. Nutcracker phenomenon of the renal vein and venous pathology of the left kidney[J]. J Belge Radiol, 1972, 55(4):507-511.
4.	王峰, 朱育春, 卢一平, 等. 21例成年人胡桃夹综合征临床诊治分析[J].华西医学, 2009, 24(5):1103-1105.
5.	谭继初, 漆平. CTA显示肠系膜上动脉起始段解剖的价值及临床意义[J].广东医学, 2010, 31(9):1283-1285.
6.	杨兵, 胡亚飞, 谭必勇, 等.肠系膜上动脉彩色多普勒超声检查方法学研究[J].中华医学超声杂志, 2012, 9(1):12-15.
7.	姜洪标, 崔磊, 崔海燕, 等.腹主动脉-肠系膜上动脉夹角的MR血管成像测量及其与体重指数的关系[J].中国医学影像学杂志, 2012, 20(10):741-744.
8.	赵龙, 史河水, 韩萍, 等.胡桃夹综合征的MSCTA与DSA对比研究[J].临床放射学杂志, 2009, 8(11), 1509-1512.
9.	Zhang H, Li M, Jin M, et al. The left renal entrapnent syndrome diagnosis and treatment[J]. Ann Vasc Surg, 2007, 21(2):198-203.
10.	戚跃勇, 邹利光, 陈林, 等. MSCT重组技术对左肾静脉压迫综合症的诊断价值[J].临床放射性杂志, 2008, 27(1):93-96.
11.	Kaneko K, Kiya K, Nishimura K, et al. Nutcracker phenomenon demonstrated by three-dimensional computed tomography[J]. Pediatr Nephrol, 2001, 16(9):745-747.
12.	Matheus Cde O, Waisberg J, Zewer MH, et al. Syndrome of duodenal compression by the superior mesenteric artery following restorative proctocolectomy:a case report and review of literature[J]. Sao Paulo Med J, 2005, 123(3):151-153.
13.	Clapp B, Applebaum B. Superior mesenteric artery syndrome after Roux-en-Y gastric bypass[J]. JSLS, 2010, 14(1):143-146.

1. 许传斌, 唐发功.肠系膜上动脉的正常CT结构学研究[J].中国局解手术学杂志, 2003, 12(1):8-9.
2. Cheen JE, Kim WS, Kim IO, et al. Nutcracker syndrome in children with gross hematuria:Doppler sonographic evaluation of the left renal vein[J]. Pediatr Raidiol, 2006, 36(7):682-686.
3. De Schepper A. Nutcracker phenomenon of the renal vein and venous pathology of the left kidney[J]. J Belge Radiol, 1972, 55(4):507-511.
4. 王峰, 朱育春, 卢一平, 等. 21例成年人胡桃夹综合征临床诊治分析[J].华西医学, 2009, 24(5):1103-1105.
5. 谭继初, 漆平. CTA显示肠系膜上动脉起始段解剖的价值及临床意义[J].广东医学, 2010, 31(9):1283-1285.
6. 杨兵, 胡亚飞, 谭必勇, 等.肠系膜上动脉彩色多普勒超声检查方法学研究[J].中华医学超声杂志, 2012, 9(1):12-15.
7. 姜洪标, 崔磊, 崔海燕, 等.腹主动脉-肠系膜上动脉夹角的MR血管成像测量及其与体重指数的关系[J].中国医学影像学杂志, 2012, 20(10):741-744.
8. 赵龙, 史河水, 韩萍, 等.胡桃夹综合征的MSCTA与DSA对比研究[J].临床放射学杂志, 2009, 8(11), 1509-1512.
9. Zhang H, Li M, Jin M, et al. The left renal entrapnent syndrome diagnosis and treatment[J]. Ann Vasc Surg, 2007, 21(2):198-203.
10. 戚跃勇, 邹利光, 陈林, 等. MSCT重组技术对左肾静脉压迫综合症的诊断价值[J].临床放射性杂志, 2008, 27(1):93-96.
11. Kaneko K, Kiya K, Nishimura K, et al. Nutcracker phenomenon demonstrated by three-dimensional computed tomography[J]. Pediatr Nephrol, 2001, 16(9):745-747.
12. Matheus Cde O, Waisberg J, Zewer MH, et al. Syndrome of duodenal compression by the superior mesenteric artery following restorative proctocolectomy:a case report and review of literature[J]. Sao Paulo Med J, 2005, 123(3):151-153.
13. Clapp B, Applebaum B. Superior mesenteric artery syndrome after Roux-en-Y gastric bypass[J]. JSLS, 2010, 14(1):143-146.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of Mulit-Slice CT in Diagnosing Nutcracker Phenomenon

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