胡桃夹综合征的诊断和治疗策略  

Diagnostic and therapeutic strategies for nutcracker syndrome

作　　者：张波 何大立 焦勇 ZHANG Bo;HE Dali;JIAO Yong(Department of Urology,Tangdu Hospital,Air Force Military Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学唐都医院泌尿外科,陕西西安710038

出　　处：《现代泌尿外科杂志》2022年第12期993-998,共6页Journal of Modern Urology

摘　　要：胡桃夹综合征(NCS)是由于左肾静脉受到外源性压迫,引起血液回流受阻,造成左肾静脉高压状态,表现为血尿、蛋白尿、腰腹疼痛、女性盆腔淤血综合征、男性左侧精索静脉曲张、慢性疲劳综合征等,甚至可发展为血栓或慢性肾病(CKD)临床症候群。该病的诊断目前没有统一的标准,通常涉及多普勒超声、计算机断层扫描(CT)、磁共振成像(MRI)等检查。若诊断困难,需要行左肾静脉造影和压力梯度测量来明确诊断。对于未成年NCS患者应首选保守治疗,若病情进展或症状严重应及时外科干预。治疗手段从以往创伤大的手术逐渐发展至微创手术。目前主要采取的方案有血管内支架和血管外支架。新兴技术3D打印个性化血管外支架为NCS的治疗提供了一个新的安全有效选择。采取何种方案应根据患者年龄、症状严重程度,以及治疗条件的可及性考虑。Nutcracker syndrome(NCS)is caused by exogenous compression on the left renal vein,resulting in obstruction of blood return and left renal vein hypertension.The clinical manifestations include hematuria,proteinuria,waist and abdomen pain,pelvic congestion syndrome in women,left varicocele in men,chronic fatigue syndrome,and so on.NCS can even develop into thrombosis or chronic kidney disease(CKD).There is currently no unified standard for the diagnosis of the disease,which usually involves Doppler ultrasound,CT,MRI,and other tests.If the diagnosis is difficult,left renal venography and pressure gradient measurement are required.Conservative treatment should be the first choice for non-adult patients,and surgical intervention should be timely if the disease progresses or the symptoms are severe.The treatment method has gradually developed from the previous traumatic surgery to minimally invasive surgery.The main solutions currently adopted are intravascular stent and extravascular stent.The emerging technology of 3D printing personalized extravascular stent provides a new,safe and effective option for the treatment of NCS.The choice of regimen should be considered based on the age of patients,severity of symptoms,and availability of treatment conditions.

关 键 词：胡桃夹综合征 左肾静脉高压 腹主动脉 肠系膜上动脉 3D打印个性化血管外支架 血管内支架 

分 类 号：Q813.1[生物学—生物工程]