The Clinical Treatment and Diagnosis Analysis of 21 Cases of Nutcracker Syndrome in Adult Patients_West China Medical Journal

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Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, China;

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Keywords：

胡桃夹综合征; 左肾静脉; 血尿

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摘要:目的:探讨胡桃夹综合征(NCS)在成年患者中的临床表现、诊断及治疗特点。方法:回顾性分析四川大学华西医院泌尿外科2001年2月至2008年11月期间收治入院的21例胡桃夹综合征患者的临床病历资料。结果:21例患者男性15例,女性6例。以血尿为最主要的症状,其中19例(9048%)为肉眼血尿,2例(952%)为显微镜下血尿。17例(8095%)患者尿中正常形态红细胞≥85%,11例(5238%)患者尿蛋白呈阳性,9例(4286%)患者彩超发现平卧位左肾静脉最宽处内径(a)与最窄处内径(b)比值均数为45±24,直立位a/b均数为81±26。15例(7143%)患者CT呈现左肾静脉受压表现,8例(3809%)患者膀胱镜检见左侧输尿管口喷血。7例(3333%)行左肾静脉下移—下腔静脉端侧吻合术,平均血管阻断时间23±554min,血尿、蛋白尿在术后消失,其余14例(6667%)行保守治疗,获得随访的5例患者中有3例血尿消失,2例患者仍有无症状性血尿和蛋白尿。结论:尿红细胞形态、肾血管彩色超声、增强CT、核磁共振(MRI)及膀胱镜检查对胡桃夹综合征的诊断具有重要价值,左肾静脉下移—下腔静脉端侧吻合术治疗胡桃夹综合征效果明确,术后并发症少。 关键词:胡桃夹综合征;左肾静脉;血尿

Citation： WANG Feng,ZHU Yuchun,LU Y i ping,et al.. The Clinical Treatment and Diagnosis Analysis of 21 Cases of Nutcracker Syndrome in Adult Patients. West China Medical Journal, 2009, 24(5): 1103-1105. doi: Copy

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.	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.	VEHASKARI V M. Mechanism of orthostatic proteinuria[J]. Pediatr Nephrol,1990,4(4):328330.
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. 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. 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. VEHASKARI V M. Mechanism of orthostatic proteinuria[J]. Pediatr Nephrol,1990,4(4):328330.
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.

West China Medical Journal

The Clinical Treatment and Diagnosis Analysis of 21 Cases of Nutcracker Syndrome in Adult Patients

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