超声在胡桃夹综合征3D打印血管外支架治疗评价中的临床价值  

The clinical value of ultrasound examination in evaluating the therapeutic effect of patients with nutcracker syndrome treated with three-dimensional printing extra vascular titanium stent

作　　者：王丁一 王臻 段云友 曹铁生 张波 杜京奚 王鹏 杨勇 Wang Dingyi;Wang Zhen;Duan Yunyou;Cao Tiesheng;Zhang Bo;Du Jingxi;Wang Peng;Yang Yong(Department of Ultrasound Medicine,the Second Hospital Affiliated to Airforce Military Medical University,Xi′an 710038,China;School of Aerospace Medicine,Airforce Military Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第二附属医院超声医学科,西安710038 [2]空军军医大学航空航天医学系,西安710032 [3]空军军医大学第二附属医院泌尿外科,西安710038

出　　处：《中华超声影像学杂志》2020年第4期302-307,共6页Chinese Journal of Ultrasonography

基　　金：陕西省自然科学基础研究计划(2019JM-191);空军军医大学第二附属医院科技发展创新基金(2017LCYJ009)。

摘　　要：目的:探讨超声在胡桃夹综合征(NCS)3D打印血管外支架植入术疗效评价中的临床价值。方法:纳入2015年12月至2018年12月在空军军医大学第二附属医院拟行腹腔镜3D打印血管外支架植入术治疗的NCS患者41例。所有患者于术前及术后1周分别行超声及CT血管造影(CTA)检查,评估左肾静脉受压情况及相关血流动力学改变。结果:术前超声显示腹主动脉与肠系膜上动脉之间的夹角为(21.29±4.53)°,术后为(47.42±7.45)°,较术前显著改善(P<0.001)。术前可见左肾静脉明显受压,最细处内径仅为(1.51±0.49)mm,且血流峰值速度为(143.92±50.40)cm/s;术后超声检查显示左肾静脉受压狭窄处明显扩张,未见高速血流;术后肾门处左肾静脉内径、肾门处左肾静脉血流速度、精索静脉内径较术前均显著改善(P<0.001)。与超声检查结果类似,CTA亦发现术后腹主动脉与肠系膜上动脉之间的夹角较术前显著增大[(17.59±4.56)°对(52.27±9.01)°,P<0.001],术前CTA测得左肾静脉受压处内径为(2.09±0.86)mm,术后明显扩张,肾门处左肾静脉内径治疗后显著减小(P<0.001)。结论:超声检查能够有效评估NCS患者3D打印血管外支架植入术治疗前后的左肾静脉受压情况及相关血流动力学改变,可为该类患者的临床疗效评价提供一种可靠方法。Objective To investigate the application of ultrasound imaging in evaluating the curative effect of patients with nutcracker syndrome(NCS)treated with three-dimensional(3D)printing extravascular titanium stents.Methods From December 2015 to December 2018,a total of 41 NCS patients enrolled in the Second Affiliated Hospital of the Air Force Military Medical University to receive 3D-printing extravascular titanium stents treatment were included in this study.Ultrasound and CT angiography(CTA)were performed before and 1 week after operation to evaluate the compression of left renal vein and related hemodynamic changes.Results Before the operative,the ultrasound examination showed that the angle between the abdominal aorta and superior mesenteric artery was(21.29±4.53)°,which was significantly improved in 1 week after treatment[(47.42±7.45)°,P<0.001].Left renal vein was significantly compressed before treatment,with the smallest inner diameter of(1.51±0.49)mm and its peak blood flow velocity was(143.92±50.40)cm/s.Postoperative ultrasound images showed the significant expansion of left renal vein and no high velocity blood flow was observed.Ultrasound examination also showed that the diameter of left renal vein at renal hilum,blood flow velocity at renal hilum and inner diameter of spermatic vein were significantly improved after treatment(P<0.001).Similar to ultrasound results,CTA also found that the angle between abdominal aorta and superior mesenteric artery increased significantly after treatment[(17.59±4.56)°vs(52.27±9.01)°,P<0.001].CTA also showed the left renal vein was compressed before treatment,with the smallest inner diameter of(2.09±0.86)mm,and it was significantly expanded after operation.The inner diameter of left renal vein at renal hilum was also significantly reduced after treatment(P<0.001).Conclusions Ultrasound imaging can effectively evaluate the LRV compression and related hemodynamic changes before and after 3D printed stent implantation treatment in NCS patients and provide a reliabl

关 键 词：超声检查 胡桃夹综合征 3D打印 血管外支架 计算机断层扫描血管造影 

分 类 号：R699[医药卫生—泌尿科学] R692[医药卫生—外科学] R44[医药卫生—临床医学]