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肾静脉外支架固定术治疗左肾静脉压迫综合征
引用本文:赵高贤,孟庆军,张卫星,杨锦建,李刚,管建云,冯留顺.肾静脉外支架固定术治疗左肾静脉压迫综合征[J].中华泌尿外科杂志,2009,30(4).
作者姓名:赵高贤  孟庆军  张卫星  杨锦建  李刚  管建云  冯留顺
作者单位:郑州大学第一附属医院泌尿外科,450052
摘    要:目的 探讨肾静脉外支架固定术治疗左肾静脉压迫综合征的临床疗效.方法 左肾静脉压迫综合征患者8例.男7例,女1例.平均年龄16(6~25)岁.血尿病史6~36个月,合并蛋白尿2例.均行彩色多普勒超声检查,左肾静脉狭窄段平均直径2.2 mm、最大流速0.7 m/s,扩张段平均直径8.6 mm、最大流速0.2 m/s,扩张段与狭窄段直径比值均3(正常比值<2).CT三维血管重建检查5例示腹主动脉与肠系膜上动脉夹角30°~40°(正常值45°~60°).膀胱镜检查5例可见左输尿管口喷血尿.8例均行肾静脉外支架同定术治疗,取一段长5~10 cm、直径1 cm的人造血管纵行切开,环绕左肾静脉一端至肾门,另一端越过肠系膜上动脉与主动脉间夹角形成一隧道样外支架以减轻肾静脉受压.结果 8例手术均顺利完成.平均手术时间150 min.平均术中出血量50ml.术中术后无明显外科并发症,术后恢复顺利,平均9 d出院.肉眼血尿消失6例、减轻2例.彩色多普勒超声检查7例显示左肾静脉血最大流速0.4~0.7 m/s、无明显受压.术后随访2~24个月,平均10个月,除1例时有活动性肉眼血尿、超声检查显示左肾静脉仍有受压征象外,余7例症状消失、尿常规检查正常、超声检查示左肾静脉血流通畅、受压现象消失.结论 左肾静脉外支架固定术采用人造血管环绕肾静脉抵抗肠系膜上动脉压迫,设计巧妙、损伤小、疗效满意,是治疗左肾静脉压迫综合征的理想方法.

关 键 词:左肾静脉压迫综合征  支架  人造血管

Artificial blood vessel sheath around renal vein for the treatment of left renal vein entrapment syndrome
ZHAO Gao-xian,MENG Qing-jun,ZHANG Wei-xing,YANG Jin-jian,LI Gang,GUAN Jian-yun,FENG Liu-shun.Artificial blood vessel sheath around renal vein for the treatment of left renal vein entrapment syndrome[J].Chinese Journal of Urology,2009,30(4).
Authors:ZHAO Gao-xian  MENG Qing-jun  ZHANG Wei-xing  YANG Jin-jian  LI Gang  GUAN Jian-yun  FENG Liu-shun
Abstract:Objective To explore the clinical efficacy of artificial blood vessel sheath around re-nal vein for the treatment of left renal vein entrapment syndrome. Methods Eight cases with left re-nal vein entrapment syndrome (7 males and 1 female, mean age, 16 years) with history of gross hema-turia for 6 to 36 months were reviewed. Doppler ultrasound reports suggested compression of the left renal vein at mesenteric angle in all eases. CT scan showed the abnormal angle between aorta and su-perior mesenterie artery in 5 cases. Cystscopy showed hematuria from the left ureteral orifice in 5 ca-ses. All cases with left renal vein entrapment syndrome were treated ,with the method of putting artifi-cial blood vessel as a sheath around left renal vein. Results The operations were all successful. The average operation time was 150 min, the average blood loss was 50 ml, and the average hospital stay after operation was 9 d. No surgical complications occurred. The gross hcmaturia disappeared in 6 ca-ses and Doppler ultrasound showed that left renal vein outflow was normal in 7 when the patients dis-charged from the hospital. The gross hematuria disappeared during 2-24 months' follow-up in 7 pa-tients. Conclusions The surgical aim of renal vein entrapment syndrome is to reduce the compres-sion of renal vein. The method of putting artificial blood vessel around renal vein could be a simple, safe and effective method.
Keywords:Left renal vein entrapment syndrome  Stents  Artificial blood vessel
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