不阻断肾动脉左肾静脉移位术治疗胡桃夹综合征的临床疗效观察

目的 探讨不阻断肾动脉左肾静脉移位术治疗胡桃夹综合征的临床疗效。方法 回顾性分析山东省立第三医院泌尿外科1999年1月—2017年1月收治的10例胡桃夹综合征患者的临床资料(手术组),男8例、女2例,年龄22~53(39.9±10.5)岁,均行不阻断肾动脉左肾静脉移位术;观察手术时间、术中出血量、肾静脉阻断时间、术后引流量、拔管时间、血尿消失时间;比较手术组患者手术前后站立位和平卧位时的左肾静脉狭窄段与扩张段血管管径及血流速度。随机选取2016年7月健康管理中心体检已排除肾脏疾病的10名健康成人(对照组),男5例、女5例,年龄21~45(37.0±5.8)岁;比较手术组术后与对照组的左肾静脉血管管径、血流速度。结果 手术组10例患者手术时间(171.0±10.8)min,术中出血量(138.0±42.1)mL,肾静脉阻断时间(9.5±1.3)min,术后引流(130.0±24.5)mL,拔管时间(3.3±0.8)d,肉眼血尿消失时间为(4.2±1.2)d,镜下血尿消失时间为(7.3±1.1)d。术后随访2~6个月,平均3个月。患者术后均无血尿、蛋白尿,左肾静脉狭窄段内径较术前增加、血流速度较术前下降。比较不同体位下左肾静脉狭窄段与扩张段内径及血流速度,手术组患者术前差异均有统计学意义(P值均＜0.01),术后末次随访差异均无统计学意义(P值均＞0.05);手术组患者术后站立位左肾静脉狭窄段内径及血流速度与对照组比较,差异均无统计学意义(P值均＞0.05)。结论 不阻断肾动脉的左肾静脉移位术治疗胡桃夹综合征疗效较好。

Clinical observation of left renal vein transposition with no-blocking renal artery in the treatment of renal nutcracker syndrome

Objective To explore the clinical efficacy of left renal vein transposition for the treatment of nutcracker syndrome without blocking the renal artery.Methods Clinical data (surgery group) of 10 patients with nutcracker syndrome admitted to the Department of Urology, Shandong Provincial Third Hospital from January 1999 to January 2017 were refrospectively analyzed. There were 8 males and 2 females, aged 22-53(39.9±10.5) years old. All the patients were performed left renal vein transposition without blocking renal artery. Observations included the operation time, intraoperative blood loss, postoperative drainage, extubation time, blocking time of renal vein, and the time of disappearance of gross hematuria. Furthermore, vascular diameter and blood flow velocity of the patients were compared before and after surgery. Ten healthy adults from the health management center of our hospital were randomly selected as the control group in July 2016, including 5 males and 5 females with an aged of 21-45 (37.0±5.8) years old. Then, left renal vein diameter and blood flow velocity were compared between the postoperative surgery group and the control group.Results In surgery group, the operative time was (171.0±10.8) min, intraoperative bleeding was (138.0±42.1) mL, blocking time of renal vein was (9.5±1.3)min, postoperative drainage was (130.0±24.5) mL, and extubation time was (3.3±0.8) d, the disappearance time of macroscopic hematuria was (4.2±1.2) days, and the disappearance time of microscopic hematuria was (7.3±1.1) days. Ten patients were followed up for 2-6 months with an average of 3 months. Ten patients had no hematuria or proteinuria after surgery. The inner diameter of the stenosis segment was increased, and the blood flow velocity was decreased. Before operation, the internal diameter and blood flow velocity of different stenosis segments and dilatation segments were compared. The Results were statistically significant (all P values＜0.01). Internal diameter and the blood flow velocity of different stenosis or dilatation segments in the final follow-up were compared with those in preoperation. After operation, the stenosis segments of left renal vein was improved. There was no significant difference in the internal diameter and blood flow velocity between the surgery group and the control group (all P values＞0.05).Conclusions The left renal vein transposition without blocking the renal artery is a reliable and effective treatment for the Nutcracker syndrome.