成年人胡桃夹现象与精索静脉曲张相关性临床研究  

A study of correlation between nut-cracker phenomenon and varicocele in adults

作　　者：周忠民[1] 马洪波[1] 王彤[2] 郑杰[2] 王延珍[3] 

机构地区：[1]山东省淄博市中心医院肾内科,255036 [2]山东省淄博市中心医院泌尿外科,255036 [3]山东省淄博市中心医院超声科,255036

出　　处：《中国医师进修杂志（内科版）》2008年第10期40-43,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨成年人胡桃夹现象（NCP）与精索静脉曲张的相关性及意义。方法回顾性分析226例以无症状性血尿和（或）直立性蛋白尿（微量白蛋白尿）就诊的并经彩色多普勒超声诊断明确的成年NCP患者的临床特点，以左肾静脉受压前后比值〉12为诊断NCP现象标准，将其中184例男性NCP患者作为研究组，将同期参加体检且与之年龄匹配的男性156例，经彩色多普勒超声检查无NCP作为对照组，检查两组精索静脉曲张发病率，并比较。在研究组，详细检查NCP相关指标，采用Logistic回归分析研究NCP与精索静脉曲张的相关性。结果研究组左侧亚临床型精索静脉曲张患者22例，精索静脉曲张患者47例，总发病率37．50％（69／184）；对照组亚临床型精索静脉曲张患者13例，精索静脉曲张患者8例，总发病率13．46％（21／156）。两组比较差异有统计学意义（P=0．000）。研究组左侧亚临床型精索静脉曲张患者脊柱左侧肾静脉内径（8．41±0．11）mm，脊柱前肾静脉内径（3．65±0．11）min，二者比值2．31±0．06。肠系膜上动脉（SMA）与腹主动脉（AA）夹角（15．95±0．59）°；左侧精索静脉曲张患者脊柱前肾静脉内径（3．43±0．08）mm，脊柱左侧肾静脉内径（8．72±0．14）mm，二者比值2．54±0．08，SMA与AA夹角（14．54±0．53°。在研究组，Logistic回归分析表明SMA与AA夹角越小、脊柱左侧肾静脉内径越大、年龄越大，男性NCP患者越容易并发左侧精索静脉曲张（P=0．001）.结论成年男性NCP患者左侧精索静脉曲张发病率显著高于同年龄段非NCP成年男性，这表明在成年男性中，NCP是精索静脉曲张的一个重要病因，二者密切相关。Objective To explore the correlation and significance between adult nut-cracker phenomenon （NCP） and varicocele. Methods The clinical characters of 226 adult patients （including inpatients and outpatients ）with NCP diagnosed by color Doppler ultrasound examination were analyzed retrospectively, whose chief complaints were asymptomatic hematuria or/and orthostatic proteinuria （microalbuminuria）. The ratio of left renal vein inner diameter before and after being compressed ≥ 2 was regarded as the criteria of diagnosis of NCP. Among 226 cases, 184 male NCP patients were taken as study group, and the incidence of varicocele was tested. One hundred and fifty-six male adults who had physical examination in the same period and whose ages matched with study group were taken as control group, they were not NCP pa- tients examined by color Doppler ultrasound. The incidence of varicocele was compared between two groups. The indexes associated NCP were examined in detail in study group. Logistic regression analysis was used to study the correlation between NCP and left varicocele. Results There were 184 male patients in study group, among which there were 22 patients with left sub-clinical varicocele （accounted for 11.96%）, 47 patients with left varicocele （accounted for 25.54% ）.The total incidence of vadcocele was 37.50% （69/184）. There were 156 male adults in control group, among which there were 13 patients with sub-clinical varicocele （accounted for 8.33%）, 8 patients with varicocele （accounted for 5.13%）.The total incidence of varicocele was 13.46%（21/156）. The total incidence of varicocele in study group was significantly higher than that in control group （P= 0.000）. In study group, there were 22 patients with left Sub-chnical varicocele,with average age （24.73 ± 1.03 ） years. The inner diameter of left renal vein（LRV ） in front of spine was （3.65 ± 0.11 ） mm （a）,the inner diameter of LRV at left side of spine was （ 8.41 ± 0.11 ）mm （b）, and b/a ratio

关 键 词：成年人 精索静脉曲张 自蛋白尿 胡桃夹现象 

分 类 号：R697.24[医药卫生—泌尿科学] R692[医药卫生—外科学]