肾静脉外支架固定术治疗左肾静脉压迫综合征  

Artificial blood vessel sheath around renal vein for the treatment of left renal vein entrapment syndrome

作　　者：赵高贤[1] 孟庆军[1] 张卫星[1] 杨锦建[1] 李刚[1] 管建云[1] 冯留顺[1] 

机构地区：[1]郑州大学第一附属医院泌尿外科,450052

出　　处：《中华泌尿外科杂志》2009年第4期242-244,共3页Chinese Journal of Urology

摘　　要：目的探讨肾静脉外支架固定术治疗左肾静脉压迫综合征的临床疗效。方法左肾静脉压迫综合征患者8例。男7例，女1例。平均年龄16（6～25）岁。血尿病史6～36个月，合并蛋白尿2例。均行彩色多普勒超声检查，左肾静脉狭窄段平均直径2．2mm、最大流速0．7m／s，扩张段平均直径8．6mm、最大流速0．2m／s，扩张段与狭窄段直径比值均〉3（正常比值〈2）。CT三维血管重建检查5例示腹主动脉与肠系膜上动脉夹角30°～40°（正常值45°～60°）。膀胱镜检查5例可见左输尿管口喷血尿。8例均行肾静脉外支架固定术治疗，取一段长5～10cm、直径1cm的人造血管纵行切开，环绕左肾静脉一端至肾门，另一端越过肠系膜上动脉与主动脉间夹角形成一隧道样外支架以减轻肾静脉受压。结果8例手术均顺利完成。平均手术时问150min。平均术中出血量50ml。术中术后无明显外科并发症，术后恢复顺利，平均9d出院。肉眼血尿消失6例、减轻2例。彩色多普勒超声检查7例显示左肾静脉血最大流速0．4～0．7m／s、无明显受压。术后随访2～24个月，平均10个月，除1例时有活动性肉眼血尿、超声检查显示左肾静脉仍有受压征象外，余7例症状消失、尿常规检查正常、超声检查示左肾静脉血流通畅、受压现象消失。结论左肾静脉外支架固定术采用人造血管环绕肾静脉抵抗肠系膜上动脉压迫，设计巧妙、损伤小、疗效满意，是治疗左肾静脉压迫综合征的理想方法。Objective To explore the clinical efficacy of artificial blood vessel sheath around renal vein for the treatment of left renal vein entrapment syndrome. Methods Eight cases with left renal vein entrapment syndrome （7 males and 1 female; mean age, 16 years） with history of gross hema turia for 6 to 36 months were reviewed. Doppler ultrasound reports suggested compression of the left renal vein at mesenteric angle in all cases. CT scan showed the abnormal angle between aorta and superior mesenteric artery in 5 cases. Cystscopy showed hematuria from the left ureteral orifice in 5 cases. All cases with left renal vein entrapment syndrome were treated .with the method of putting artificial blood vessel as a sheath around left renal vein. Results The operations were all successful. The average operation time was 150 rain, the average blood loss was 50 ml, and the average hospital stay after operation was 9 d. No surgical complications occurred. The gross hematuria disappeared in 6 cases and Doppler ultrasound showed that left renal vein outflow was normal in 7 when the patients discharged from the hospital. The gross hematuria disappeared during 2-24 months＇ follow up in 7 patients. Conclusions The surgical aim of renal vein entrapment syndrome is to reduce the compression of renal vein. The method of putting artificial blood vessel around renal vein could be a simple,safe and effective method.

关 键 词：左肾静脉压迫综合征 支架 人造血管 

分 类 号：R686[医药卫生—骨科学]