腹腔镜下左肾静脉狭窄环切开和血管外支架固定术治疗胡桃夹综合征五例报告并文献复习  

Laparoscopic management for Nutcraker Syndrome with resection of fibrous ring and placing extravascular stent： a report of 5 cases and review of the literature

作　　者：陈绪龙[1] 陈方敏[1] 石家齐[1] 李登宝[1] 姜锡男[1] 李海峰[1] 杨昊[1] 

机构地区：[1]贵州医科大学附属医院泌尿外科,贵阳550001

出　　处：《中华泌尿外科杂志》2016年第3期179-183,共5页Chinese Journal of Urology

基　　金：贵州省科学技术厅国际合作项目[黔科合外G字（2011）7015号]

摘　　要：目的 探讨腹腔镜下左肾静脉狭窄环切开和血管外支架固定术治疗胡桃夹综合征的可行性.方法 回顾性分析2010年3月至2015年2月收治的5例胡桃夹综合征患者的临床资料,男4例,女1例.年龄28 ～40岁,平均35岁.均伴长期血尿及腰痛,血尿病史6～72个月,其中3例合并蛋白尿.术前彩色多普勒超声检查：左肾静脉在主动脉与肠系膜上动脉之间的流速峰值为110 ～ 132 cm/s,平均121cm/s;左肾静脉肾门处流速峰值为18 ～ 25 cm/s,平均21 cm/s.CT造影检查：左肾静脉受压,狭窄段内径为1.2～2.5 mm,平均1.8 mm;左肾静脉扩张段最大内径8.3 ～15.2 mm,平均10.1 mm;扩张段与狭窄段内径比值3.4 ～9.5.膀胱镜检查：3例左输尿管管口喷血.5例均全麻下行腹腔镜下左肾静脉周围狭窄环切开和外支架固定术,术中见下腔静脉-左肾静脉连接部周围纤维狭窄环形成.切开狭窄环,置入外支架长度3.5～4.5 cm,平均4.0 cm.结果 5例手术过程顺利,手术时间75 ～ 145 min,平均83 min.术中出血量50 ～120ml,平均65ml.5例的肉眼血尿症状于术后5～6d逐渐减轻,7～20 d完全消失.3例术前蛋白尿患者于术后2周尿蛋白转为阴性,随访8 ～ 24个月未见复发.术后3d复查彩色多普勒超声：左肾静脉狭窄段内径3.8 ～5.6 mm,平均4.9mm;扩张段与狭窄段内径比值1.1 ～2.0,平均1.6;主动脉与肠系膜上动脉之间的左肾静脉血流峰速25 ～45 cm/s,平均34 cm/s.术后6个月CT血管造影检查：主动脉与肠系膜上动脉之间的左肾静脉已无受压表现,左肾静脉于肾门处最大径为7.9～9.8 mm,于主动脉与肠系膜上动脉间的最大径为6.0～8.8 mm.结论 胡桃夹综合征的病因除了左肾静脉受解剖结构挤压外,可能还与下腔静脉-左肾静脉流出端周围纤维狭窄环的形成有关.腹腔镜下下腔静脉-左肾静脉流出端周围纤维狭窄环切开和血管外支架固定术是治疗胡桃夹综合征的一种有效、微创的治疗手Objective To investigate the Laparoscopic management for Nutcraker Syndrome（NCS） with resection of fibrous ring and placing extravascular stent.Methods This was a retrospective analysis of clinical data and treatment process of cases from March 2010 to February 2015 in urology department,affiliated hospital of Guizhou medical university.Five cases with NCS,4 males and 1 female;age were 28-40 years,mean age was 35 years,all cases were afflicted with gross hematuria and flank pain,the history of gross hematuria were 6-72 months.3 cases were afflicted with proteinuria.Duplex ultrasound scanning before surgery revealed the compressed left renal vein （LRV） between the aorta and the superior mesenteric artery（SMA）,with peak velocity 110-132 cm/s,an average of 121 cm/s.The flow velocity of LRV in the renal hilum were 18-25 cm/s,an average of 21 cm/s.CT scanning showed that the stricture segment diameter of LRV were 1.2-2.5 mm,an average of 1.8 mm;and the max diameter of proximal dilatation of the LRV in renal hilum were 8.3-15.2 mm,an average of 10.1 mm.The ratio between the dilated segment inner diameter and the stricture segment were 3.4-9.5.Bleeding from the left ureteral orifice was detected by cystoscopy in 3 cases.5 cases were treated by resection of fibrous ring and placing extravascular stent with Laparoscopic management,and the average length of extravascular stent was 4.0 cm.Results The operation was successful in the 5 cases.The average operation time was 83 min.The average blood loss was 65 ml.Hematuria gradually reduce 5-6 days and resolved 7-20 days after surgery in 5 patients.Proteinuria was disappeared successful 2 weeks after surgery in 3 patients.There was no recurrence at 8-24 months＇ follow-up.3 days after surgery Doppler ultrasound showed the stricture segment diameter of LRV were 3.8-5.6 mm,an average of 4.9 mm;the ratio between the dilated segment inner diameter and the stricture segment decreased were 1.1-2.0,an average of 1.6;the peak velocity of compressed LRV were 25-45 cm/s,an a

关 键 词：腹腔镜 胡桃夹综合征 血管外支架固定 纤维环 

分 类 号：R699[医药卫生—泌尿科学]