成人胡桃夹现象的诊断与治疗  

Diagnosis and therapy of the nutcracker phenomenon: long-term follow-up

作　　者：林维勤[1] 黄洪锋[1] 李鸣[2] 汪忠镐[2] 陈江华[1] 贺学林[1] 周进淇[3] 

机构地区：[1]浙江大学医学院附属第一医院肾脏病中心,杭州310003 [2]浙江大学医学院附属第一医院血管外科,杭州310003 [3]浙江大学医学院附属第一医院放射科,杭州310003

出　　处：《中华外科杂志》2003年第12期889-892,共4页Chinese Journal of Surgery

摘　　要：目的　探讨成人胡桃夹现象 (NCP)的诊断与治疗。　方法　总结 1998年 10月至 2 0 0 2年 8月高度疑诊NCP的患者 31例 ,采用多普勒彩色超声等检查确诊NCP患者 13例 ,6例NCP采取外科治疗 ,其中 3例行肠系膜上动脉移位术 (SMAT) ,另 3例行左肾静脉狭窄处血管支架置放术 (ES) ,术前及术后行多普勒彩色超声及尿液检查。　结果　 13例NCP患者与 18例非NCP患者相比 ,在左肾静脉狭窄处内径 (b值 )、扩张段内径 (a值 )、狭窄处血流 (Vb)、扩张段血流 (Va)、a/b比值等指标上 ,差异均有显著性意义 (P <0 0 5 )。外科治疗后b值显著增加 ,a值显著减少 ;a/b比值术前为 (4 99±0 79) ,术后为 (1 2 3± 0 16 ) ,P <0 0 1;治疗后Vb明显减慢。随访 6～ 5 0个月 ,平均 (2 4 7± 18 0 )个月 ,血尿均缓解 ,腰肋痛等症状消失。 3例SMAT术后并发后腹膜血肿 1例 (二次手术止血 ) ,麻痹性肠梗阻 1例次 ,肠功能紊乱 1例次 ,均保守治疗成功。 3例ES术后无并发症发生。结论　多普勒彩色超声检查在成人NCP的诊断中具有重要价值。SMAT和ES外科方法治疗成人NCP均有良好的疗效 ,但ES手术安全性更高 ,同时具有组织损伤小、住院时间短、并发症少、无刀疤等优点 ,为治疗成人NCP提供了一种全新的治疗手段。Objective To study the diagnosis of adult nutcracker phenomenon(NCP) and assess the therapeutic value of endovascular stenting(ES) and superior mesentery artery transposition(SMAT) for the treatment of NCP in long-term follow-up. Methods Six patients (6 men) aged 16 and 34 years old (mean age, 22.7±18.0 years) were diagnosised as having NCP using the examination of the doppler ultrasound and/or magnetic resonance of artery/digital radiography(MRA/DSA). Three patients underwent ES and 3 patients received SMAT for the treatment of the NCP patients associated with recurrent gross hematuria and left flank pain. Doppler ultrasound and urine examination were used at pre- and post-operation. Results In 3 patients who underwent SMAT, the postoperative complications comprised retroperitoneal hematoma necessitating surgical revision (n=1). Functional disorder of intestine (n=1) and paralytic ileus (n=1) that were resolved by conservative management. In 3 patients who experienced ES, 1 patient received surgical revision because the position of stent was not suitable in left renal vein but no other complication took place. During the follow-up of 6～50 months(mean 24.7±18.0 months), except that 1 patient′s hematuria disappears at rest and reappears after motion while the other 5 patients remain asymptomatic and free of hematuria. The dopplar ultrasound showed the left renal vein diameters of the angel segment between superior mesentery artery and aorta were (0.18±0.05) cm preoperation and (0.65±0.17) cm postoperation, P<0.001;the left renal vein diameters of the portal segment were (0.89±0.22) cm preoperation and (0.79±0.20) cm postoperation, P=0.003; the left renal vein diameter's ratio between portal and angel segment were (4.99±0.79) preoperation and (1.23±0.16) postoperation, P<0.001. Conclusions Dopplar ultrasound plays a very important role in the diagnosis of adult NCP. SMAT is an efficient surgical approach to the treatment of the nutcracker phenomenon and is associated with an acceptable risk o

关 键 词：胡桃夹现象 诊断 治疗 肾疾病 肾静脉 血管疾病 

分 类 号：R692.9[医药卫生—泌尿科学]