多排螺旋CT诊断非夹角原因引起胡桃夹综合征的临床价值  

The clinical value of multi-slice spiral CT in diagnosis of non-angle caused nutcracker syndrome

作　　者：郝培培[1] 杨学华[1] 张永高[1] 

机构地区：[1]郑州大学第一附属医院放射科,河南郑州450052

出　　处：《实用放射学杂志》2014年第4期631-634,共4页Journal of Practical Radiology

摘　　要：目的：探讨多排螺旋CT诊断非夹角原因引起胡桃夹综合征的临床价值。方法回顾性分析临床怀疑胡桃夹综合征行多排螺旋CT肾脏检查的患者177例，其中阴性患者33例，阳性患者144例；通过测量肠系膜上动脉与腹主动脉夹角，肠系膜上动脉后方左肾静脉管径与扩张处管径及比值，以及左肾静脉解剖学形态，了解非夹角原因引起的胡桃夹综合征阳性患者的影像学表现。结果33例胡桃夹阴性患者中，肠系膜上动脉与腹主动脉夹角为（46.06＆#177;24.46）＆#176;；左肾静脉通过肠系膜上动脉后方时最窄处与扩张处管径的比值为2.11＆#177;0.76。144例诊断为胡桃夹阳性的患者，肠系膜上动脉与腹主动脉夹角为（23.10＆#177;9.63）＆#176;；左肾静脉通过肠系膜上动脉后方时最窄处与扩张段管径比值为3.83＆#177;1.24。阳性组与阴性组之间，角度与比值两者有显著差异（P＜0.05）。其中有9例为非夹角原因引起的胡桃夹阳性：3例胰头钩突压迫；2例左肾静脉畸形；1例后胡桃夹；1例门静脉压迫；1例为左肾静脉迂曲盘绕肾动脉，引起左肾静脉管腔明显受压；1例为肠系膜上动脉与腹主动脉前后径过短，十二指肠与左肾静脉平行，左肾静脉管腔受压变窄，导致左肾静脉明显受压。结论多排螺旋 CT 血管重建能清楚显示左肾静脉受压原因及部位，有助于对非典型胡桃夹综合征的临床诊断。Objective To evaluate the diagnostic value of multi-slice spiral CT for non-angle caused nutcracker syndrome（NCS）. Methods A total of 177 cases of clinical suspected nutcracker syndrome patients recevied multi-slice spiral CT examination,,inclu-ding 33 patients with negative results,144 cases patients with positive results.The analysis was performed by measuring the angle between superior mesenteric artery（SMA）and the abdominal aorta（AA）,and the ratio of the diameter of the narrowest and expan-sion in the left renal vein.Results Within 33 cases of nutcracker-negative patients,the angle of SMA and AA was （46.06 ＆#177; 24.46）＆#176;;the ratio was （2.11＆#177;0.76）.144 cases was diagnosed as nutcracker-positive patients,the angle of SMA and AA was （23. 10＆#177;9.63）＆#176;;the ratio was （3.83＆#177;1.24）.There was positive correlation between angle and ratio in NCS （P＜0.0001）.Among9 ca-ses of nutcracker syndrome caused by non-angle factors three were oppressed by the uncinate process pancreas,two cases were caused by the malformations of the left renal vein,one case was posterior nutcracker syndrome,one case was oppressed by portal veinOne case of pressured renal vein due to tortuosity renal vein coiled renal artery.One case of the left renal vein compression lumen narrowing,causing significant downward pressure on the left renal vein.Conclusion Spiral CT angiography reconstruction can clear-ly show the cause and the location of the left renal vein compression,which may provide helpful information in diagnosing nutcracker syndrome caused by non-angle factors.

关 键 词：胡桃夹综合征 非夹角 计算机体层成像 肠系膜上动脉 

分 类 号：R692[医药卫生—泌尿科学] R814.42[医药卫生—外科学]