胡桃夹综合征诊治进展

胡桃夹综合征，又称为胡桃夹现象或左肾静脉受压综合征，是指左肾静脉在汇入下腔静脉的行程中，穿过腹主动脉和肠系膜上动脉之间的夹角或腹主动脉和脊柱之间的间隙，受到挤压而引起血尿、蛋白尿、左腰腹痛等一系列症状的疾病。“胡桃夹现象”曾在1938年的解剖学教科书中被最早提及。1950年EL-Sadr和Mina首先描述了左肾静脉受压的表现，但未引起临床上的重视。1972年DeSchepper首先报告了胡桃夹综合征引起左肾出血，并通过膀胱镜检分侧留取尿液证实。此后随着临床检查方法的改进，胡桃夹综合征的检出率呈上升趋势。本文就其发病机理、病理生理、临床表现、诊断和治疗作一综述。     

胡桃夹现象与血尿五例

胡桃夹现象与血尿五例谢长华，尹燕秋，孙志克，陈灵单纯性血尿是儿童常见的泌尿系统症状，其病因复杂繁多，诊断很困难。现将经Ｂ超证实由胡桃夹现象所致的５例血尿报告如下：典型病例患儿，男，１２岁。因持续肉眼血尿四一余天入院。四十余天前因剧烈运动后（赛跑）出现...     

成人胡桃夹综合征合并IgA肾病30例临床分析

目的分析胡桃夹综合征合并IgA肾病患者的临床特点,提高临床医师诊治水平。方法以30例成人胡桃夹综合征合并IgA肾病患者为Ⅰ组,同期90例已行左肾静脉多普勒检查后无合并胡桃夹综合征的成人IgA肾病患者为Ⅱ组,同期60例单纯胡桃夹综合征患者为Ⅲ组。回顾性分析该3组患者的临床、实验室检查、影像学及病理资料。结果Ⅰ组中男女比为1∶3.29,女性明显多于男性。Ⅰ组及Ⅲ组体质量指数(BMI)低于Ⅱ组,Ⅰ组血清C3水平明显低于Ⅱ组,Ⅰ组中患者低C3血症发生率为56.7%,高于Ⅱ组的26.7%(P0.01)。Ⅰ组及Ⅲ组左肾静脉的狭窄处内径明显窄于Ⅱ组左肾静脉的狭窄处内径(P0.01)。结论长期胡桃夹综合征合并低C3血症成人患者,建议行肾活检明确诊断;成人女性瘦长体型IgAN患者及伴血C3下降的IgAN患者均建议行左肾静脉彩色多普勒检查,以明确是否存在胡桃夹综合征。     

左肾静脉胡桃夹征六例的诊断及治疗

我院于 1993年 1月至 1999年 4月共收治左肾静脉胡桃夹征 6例 ,现报告如下。临床资料1.一般资料 :本组共 6例 ,其中 4例患者 (男 3例 ,女 1例 ;年龄 9～ 12岁 ) ,主诉活动后出现血尿 ,Ｄｕｐｌｅｘ超声或磁共振血管造影 (ＭＲＡ)检查均证实为 :左肾静脉胡桃夹征 (轻度 ) ,暂予保守治疗。另 2例患者均为男性 ;年龄分别为 14岁、18岁 ,因反复乏力、腰酸 2年余入院。入院查体 :平卧位和直立位活动后尿检红细胞 ( ～ ) ,蛋白质 ( ～ ) ;肾功能损害 :尿素氮增高至 10 0 5ｍｍｏｌ/Ｌ ,肌酐 99μｍｏｌ/Ｌ ;Ｄｕｐｌｅｘ超声示 :左肾静脉最…     

胡桃夹综合征的诊断和治疗

胡桃夹综合征（nutcracker syndrome,NCS）,也称胡桃夹现象,是指左肾静脉（left renal vein,LRV）回注下腔静脉过程中,穿经由腹主动脉和肠系膜上动脉（superior mesenteric artery,SMA）形成的夹角,受到挤压而引起血尿、蛋白尿和左侧腰腹痛等症状的临床综合征,故又称左肾静脉受压综合征。     

左肾静脉支架术治疗胡桃夹综合征二例报告

左肾静脉压迫综合征又称胡桃夹综合征（NCS），临床少见，我们采用左肾静脉自膨式支架治疗2例，效果满意。现报告如下。 对象与方法本组2例。男女各1例，年龄分别为19、24岁。主诉反复肉眼血尿伴乏力、腰酸，病程分别为2、4年。患者入院前曾多次抗炎止血等治疗，症状未缓解。查体：2例患者均为瘦长体型，男性表现为左精索静脉曲张。     

2例胡桃夹综合征患者左肾静脉移位术的护理

对2例胡桃夹综合征患者行左肾静脉移位术,术后1～2周肉眼血尿消失,术后1个月尿常规正常,随访半年无复发.提出良好的心理护理,充分的术前准备,术后密切观察生命体征,做好引流管的护理,完善出院指导,对保证手术效果、预防和减少并发症有重要意义.     

左肾静脉支架植入术治疗胡桃夹综合征的临床疗效

目的分析支架植入术治疗胡桃夹综合征(NCS)的安全性及临床疗效,探讨国人左肾静脉支架的选用标准。方法选取接受腔内支架植入术治疗的NCS患者36例,对其临床资料进行回顾性分析。术后随访12～98个月(中位随访时间53.5个月)。结果本组技术成功率100%,向各确诊NCS者左肾静脉植入14/60mm支架1枚,无围术期严重并发症发生。术后3个月,NCS相关临床症状几乎全部消失。随访期间全部支架通畅,无支架内再狭窄及临床症状复发;2例左肾静脉内支架发生移位,但无不良事件发生。结论左肾静脉腔内支架植入术治疗NCS安全有效且微创。治疗国人NCS时,在满足形态学测量的前提下,推荐首先选择14/60mm支架。     

不同术式治疗胡桃夹综合征继发左精索静脉曲张效果分析

目的探讨不同术式治疗胡桃夹综合征(NCS)继发左精索静脉曲张的临床效果。方法回顾性分析2016-08—2021-08郑州大学第一附属医院泌尿外科行左肾静脉(LRV)外支架固定术的60例NCS继发左精索静脉曲张的青少年患者的临床资料。按不同术式分为3组,各20例。A组行腔镜手术并联合左精索静脉高位结扎术,B组行腔镜手术联合开放左精索静脉高位结扎术,C组不处理左精索静脉曲张。比较3组患者的基线资料及临床效果。结果3组患者的基线资料以及增大腹主动脉与肠系膜上动脉间的夹角、降低血尿及蛋白尿的发生率差异无统计学意义(P>0.05);A组改善精子质量、减小精索静脉内径的效果均明显优于B组、C组,差异均有统计学意义(P<0.05)。结论对于NCS继发左精索静脉曲张患者,腔镜手术、开放手术,以及是否联合左精索静脉高位结扎术,均能增大腹主动脉与肠系膜上动脉间的夹角和降低血尿及降低蛋白尿发生率;但腔镜LRV外支架固定术联合左精索静脉高位结扎术在改善精子质量、减小精索静脉内径、降低精索静脉曲张复发率等方面,具有明显优势。     

Surgical treatment of the Wolff-Parkinson-White syndrome in infants and children

Eleven pediatric Wolff-Parkinson-White (WPW) syndrome patients underwent surgery. Four had left, 5 right cardiac type and 2 had right septal type WPW syndrome. Two patients had 2 accessory conduction pathways (ACP). Ebstein's anomaly and secundum type atrial septal defect were the associated congenital cardiac diseases in one patient each. Indications for surgery included repeated and/or long-lasting paroxysmal supraventricular tachycardia (PSVT), ineffective drug therapy, cardiac failure due to frequent tachycardia, short effective refractory period of the ACP, and simultaneous surgery for associated congenital cardiac diseases. Pre- and intra-operative examinations, including ECG, VCG, UCG, body surface mapping, intracavitary recording by catheter electrodes, computerized epicardial mapping, and endocardial mapping, were performed for the precise localization of the ACP. The surgical method was basically the same as is used for adults. Anterior median stermotomy was used primarily in right cardiac and right septal type and left anterior thoracotomy was used in 3 of 4 cases of the left cardiac type. Eight of 11 cases, two of which had 2 ACPs, were completely cured and in 3 there was evidence of postoperative pre-excitation. However, the PSVT attacks disappeared almost completely and drug therapy is not required at present.     

Surgical treatment of macrodactyly in Proteus syndrome

Proteus syndrome is a rare congenital disorder composed of a wide variety of deformities including macrodactyly of the foot. A dearth of information on the surgical management of macrodatyly in Proteus syndrome exists in the literature. In this report, we present our experience in the surgical treatment of two patients with Proteus syndrome, both of whom suffered from disordered gait and problems with finding well-fitting shoes. By resection of the most enlarged ray, shortening of adjacent enlarged rays, debulking of soft tissue and ray transposition, both patients gained a fairly normal gait and were able to wear normal shoes.     

胡桃夹综合征的诊断和手术治疗(附3例报告)

目的:探讨胡桃夹综合征(NCS)的诊断与治疗。方法:NCS患者男2例,女1例,年龄14～23岁。临床主要表现为反复发作的血尿、蛋白尿和腰痛,1例并发左侧精索静脉曲张。多普勒彩色超声及CT示腹主动脉与肠系膜上动脉夹角处左肾静脉受压明显。3例患者均行左肾静脉移位术。结果:3例患者术后血尿或蛋白尿均消失,无并发症发生。术后6个月行多普勒彩色超声及尿液检查均未见异常。结论:NCS临床表现为反复发作的血尿或蛋白尿。多普勒彩色超声在NCS的诊断中具有重要价值。左肾静脉移位术是治疗NCS的有效方法。     

结核性腱鞘滑膜炎所致腕管综合征的手术治疗

目的 总结腱鞘结核所致的腕管综合征的临床表现,观察手术治疗的效果.方法 对11例术前不能明确病因的腕管综合征患者行手术治疗,广泛切除腱鞘滑膜上病灶组织,经病检确诊为结核性腱鞘滑膜炎,术后行抗痨治疗.通过随访观察症状的改善、神经肌电图的变化来评估手术疗效.结果 11例随访6～18个月,9例术后1周神经症状缓解,1个月后麻木症状消失.术后6个月临床症状和神经传导较术前明显改善,结核未复发,手指功能恢复良好,未产生并发症.结论 结核性腱鞘滑膜炎好发于腕部屈肌腱,是引起腕管综合征病因之一.手术切除病灶,加上抗痨治疗和早期功能锻炼,疗效满意.     

Klippel-Trenaunay syndrome: incidence and treatment of genitourinary sequelae

PURPOSE: Prior reviews regarding genitourinary manifestations of Klippel-Trenaunay syndrome used data acquired from diverse specialty specific articles to define the incidence and sequelae of its genitourinary manifestations. We believe that this resulted in erroneous conclusions regarding the urological complications of Klippel-Trenaunay syndrome. MATERIALS AND METHODS: Data on genitourinary manifestations in patients with Klippel-Trenaunay syndrome treated at 1 institution from 1970 through 2005 were acquired. RESULTS: Of 218 patients with Klippel-Trenaunay syndrome 30% (66 of 218) had genitourinary involvement, including 7% (15) with cutaneous genital abnormalities, 7% (15) with visceral genitourinary involvement and 16% (36) with each type. Intermittent bleeding from cutaneous genital abnormalities developed in 65% of patients (33 of 51). Conservative treatment with compression and/or cauterization was attempted in all 33 patients and it was successful in 64% (21 of 33). Intractable hemorrhage resulted in excision of the cutaneous bleeding site in 36% of cases (12 of 33). A total of 39 hospitalizations for gross hematuria occurred in 9% of the patients (19 of 218). Hematuria developed from the bladder in 11 cases, the urethra in 4 and the kidney in 4. Conservative therapy resolved gross hematuria in 21% of the patients (4 of 19). Refractory hematuria was successfully treated with cauterization in 37% of the patients (7 of 19) and by angiographic embolization in 10% (2 of 19). Intractable gross hematuria resulted in open surgical excision of the bleeding site in 32% of the patients (6 of 19). CONCLUSIONS: The incidence of genitourinary manifestations of Klippel-Trenaunay syndrome is 30%, which is triple the previously reported incidence of 9%. Unlike prior reports stating that the genitourinary abnormalities rarely caused problems, 52% of the patients (34 of 66) with Klippel-Trenaunay syndrome who had urological manifestations eventually required interventional therapy for genitourinary complications.     

布加氏综合征的介入治疗(143例经验总结)

目的　总结介入方法治疗布加氏综合征 143例的临床经验。　方法　男 92例 ,女 5 1例。年龄 6岁～ 6 5岁 ,平均 34 8岁。共 6种病理类型 :①下腔静脉 (InferiorVenaCava ,IVC)完全阻塞 71例 ;②IVC狭窄 36例 ;③IVC膜性阻塞伴小孔 2 9例 ;④肝静脉 (HV)膜性阻塞 3例 ;⑤近期IVC血栓形成 4例 ;⑥以上IVC病例中同时合并HV阻塞 14例。治疗方法包括 :(1)经股静脉行IVC破膜扩张或狭窄扩张 77例 ;(2 )经股静脉行IVC破膜扩张或狭窄扩张后IVC支架置入术 6 2例 ;(3)经皮经HV破膜扩张 3例 ;(4)经股静脉行IVC置管溶栓 4例 ;(5 )介入治疗后附加降低门脉高压手术 16例。　结果　介入治疗成功率90 2 % (12 9/ 143) ,IVC压力下降范围 (3～ 2 9)cmH2 O ,平均 12 1cmH2 O。发生并发症 8例 ,肺栓塞、支架迁移及支架术后HV阻塞各 2例 ,心包填塞和血胸各 1例。死亡 5例 ,2例死于肺栓塞 ,3例IVC支架术后二期附加肠腔侧侧分流术后死于肝昏迷 ,围手术期死亡率 3 5 % (5 / 143)。单纯IVC扩张病例复发率10 4% ,IVC扩张加支架置入术病例复发率 1 6 % ,其余各组尚无复发者。　结论　①IVC或HV局限性病变且无继发新鲜血栓者 ,应首选行破膜扩张术。②IVC破膜扩张后出现弹性回缩或复发者应行IVC支架术。③IVC病变合并HV闭塞者 ,IVC介     

Surgical treatment of non-unions of the clavicle

Surgical Principles A non-union of the clavicle can develop following a fracture, which is conservatively treated with insufficient reduction or inadequate immobilisation, as well as after an open reduction and internal fixation in cases with severe soft tissue injury or with poor osseous stabilization. Dynamic compression plating of a non-union of the clavicle provides the mechanical stability required for bone healing; in cases of atrophic non-union or pseudarthrosis with loss of bone, the procedure is supplemented with an autogenous cancellous bone graft, whereas those with associated shortening are treated with the interposition of a cortico-cancellous block. The (rare) post-traumatic thoracic outlet syndrome can frequently be treated successfully through a stable internal fixation of the pseudarthrosis. First published in: Operat. Orthop. Traumatol. 1 (1989), 139–144 (German Edition).