左肾静脉压迫综合征20例的治疗  

The treatment of left renal entrapment syndrome

作　　者：张鸿坤[1] 李鸣[1] 金炜[1] 单平[1] 潘松龄[1] 汪忠镐[1] 

机构地区：[1]浙江大学医学院附属第一医院血管外科,杭州310003

出　　处：《中华普通外科杂志》2006年第12期852-855,共4页Chinese Journal of General Surgery

摘　　要：目的探讨左肾静脉压迫综合征的治疗方法。方法对20例左肾静脉压迫综合征患者的治疗进行回顾性分析。患者均行肾血管超声,磁共振血管造影和肾静脉造影检查明确诊断; 20例患者中行肠系膜上动脉移位术3例,行左肾静脉移位术2例,行左肾静脉支架植入术15例(16次)。结果(1)术后肾血管超声检查左肾静脉近端平卧位流速明显增快,站立15 min增快更明显,流速(131±54)cm／s;平卧位左肾静脉最宽和最窄处内径比为4．4±1．6,站立15 min后为8．1±1．7,均明显大于对照组;磁共振血管造影检查本组患者腹主动脉与肠系膜上动脉之间平均夹角为(30±5)度,对照组为(64±16)度;左肾静脉造影示左肾静脉和下腔静脉平均压差为(14±5) mmHg,支架植入后压差为(2．9±1．4)mmHg,差异有统计学意义(P<0．05)。(2)20例患者手术和介入治疗顺利,2例因腹膜后血肿和支架移位而再次手术和植入支架。20例患者随访6个月至6年, 18例患者术后尿检查均阴性。2例患者术后肉眼血尿消失,但活动后仍有镜下血尿。结论超声、MRA和左肾静脉造影可确诊左肾静脉压迫综合征。经股静脉左肾静脉支架植入术创伤小,是今后的治疗方向之一。Objective To explore the treatment of left renal entrapment syndrome. Methods A retrospective analysis was made on the treatment of left renal entrapment syndrome. Diagnosis was established with ultrasonography, magnetic resonance angiography （MRA） and left renal venography. The transposition of the superior mesenteric artery（SMA） was performed in three cases, the transposition of left renal vein（LRV） in two, and the stent implantation of the LRV in 15. Results Ultrasonography showed that the flow velocity of the proximal end of the LRV at horizontal position accelerates remarkably, and the acceleration is more obvious after standing for 15 minutes; The inner diameter ratio of the broadest place to the narrowest of the LRV at horizontal position is 4. 4 ± 1.6, while it is 8. 1 ± 1.7 after standing for 15 minutes. MRA illustrated the angle between the abdominal aorta and the SMA was （ 30 ± 5 ） °, the control was （64 ± 16）°. The average pressure difference between the LRV and the inferior vena cava （IVC） was （ 14 ± 5 ） mmHg and （2.9 ± 1.4） mmHg before and after stent implantation. The surgical and interventional therapy was successful in all 20 cases. Follow-up from 6 months to 6 years revealed that macroscopic hematuria and symptom disappeared in all patients. Conclusion Ultrasonography, MRA and renal venography are decisive for the establishment of final diagnosis of left renal entrapment syndrome. The stent implantation is the choice of therapy because of less invasion.

关 键 词：综合征 血管外科手术 肾静脉 支架 

分 类 号：R692[医药卫生—泌尿科学]