"胡桃夹症"临床症状和影像学表现的探讨(附13例报告)

目的：提高对“胡桃夹症”的诊断水平。方法：回顾性分析13例“胡桃夹症”患者的临床资料。结果：10例首发症状为血尿，2例首发症状为左侧阴囊内蚯蚓状肿物，以左侧精索静脉曲张就诊，1例首发症状为蛋白尿。1例女性患者伴月经量增大。男性患者均有左侧精索静脉曲张。血管多普勒超声提示左肾静脉通过腹主动脉和肠系膜上动脉之间有受压征象，径线1．6～6．1inin，平均2．64mm。肾门静脉段呈增粗改变，径线7．1～21．0mm，平均10．9mm。增强CT扫描横断面可见腹主动脉和肠系膜上动脉之间挤压左肾静脉，矢状面可见肠系膜上动脉与腹主动脉成锐角，其间的通道变窄。2例肾静脉造影提示左肾静脉过腹主动脉和肠系膜上动脉段处变窄。4例膀胱镜检查可见左侧输尿管口喷血。结论：血尿、蛋白尿、左侧精索静脉曲张是“胡桃夹症”的重要临床症状。多普勒超声、CT是“胡桃夹症”重要的无创性诊断方法。

Evaluation of the clinical Symptoms and the images of nutcracker syndrome (Report of 13 cases)

Objective:To improve the standard of diagnosis of nutcracker syndrome.Methods:The data of 13 cases of nutcracker syndrome were analysed.Results:Ten patients had complaints of hematuria and two patients had left varicocele. One patient had proteinuria. One Female had increased catamenia. All of the men had varicocele signs. The urinalysis showed that ten patients had hematuria and one patient had proteinuria. Color Doppler ultrasound findings implied compression of the left renal vein in all aortomesenteric patients in all patients. The anteroposterior diameter varied from 1.6to 6.1 mm with a mean of 2.64 mm. The diameter in hilar portions varied from 7.1to 21.0 mm with a mean of 10.9 mm. CT provided fine outlines of compression of the left renal vein between the aorta and the superior mesenteric artery and the abnormal acute angle between them in 13 patients. Some degree of obstruction was observed in the notch between the aorta and superior mesenteric artery in tow patients on selective left renal angiography. Cystoscopic examintion revealed bloody urine emerging from the left ureteral orifice.Conclusions:Hematuria, proteinuria and varicocele are important clinical symptoms of the nutcracker syndrome. Doppler ultrasound and computed tomography scan of the left renal vein may be useful screening tool in patients with suspected nutcracker syndrome. The diagnosis of nutcracker syndrome must depend on clinical symptoms and the image findings.