胡桃夹综合征的手术治疗

目的提高对胡桃夹症的认识,改进治疗左肾静脉胡桃夹综合征的手术方法。方法回顾性分析3例采用左肾静脉下移与下腔静脉端侧吻合术治疗的胡桃夹症患者的临床资料。结果3例患者症状均为反复血尿,彩色多普勒超声示胡桃夹现象患者左肾静脉最宽和最窄处内径比均>3,近端血流速度明显增快,且站立15m in后更明显。肉眼血尿消失时间分别在术后第2、5、4天,镜下血尿消失时间分别在术后第4、6、6天,随访至少4个月,症状消失无复发。结论彩色多普勒超声是术前诊断胡桃夹综合征的首选方法;左肾静脉下移与下腔静脉端侧吻合术治疗左肾静脉胡桃夹综合征,方法较安全,效果好。

Surgical treatment of nutcracker syndrome

Objective To improve the standard of understandings of nutcracker syndrome.Methods The data of 3 cases of nutcracker syndrome underwent transposition of the left renal vein were reviewed.Results Three patients all had complaints of hematuria.Blood flow of the proximal left renal vein was increased.The ratios of distal unrestricted interdiameter and proximal restricted were also increased(>3),and even more after standing for 15 minutes in patients with nutcracker syndrome.The gross hematuria disappeared 2,5,and 4 days respectively after surgery,and microhematuria ceased spontaneously 4,6,and 6 days respectively after surgery.Transposition of the left vein effectively relieved the symptoms related to the letf renal vein nutcracker syndrome.The patients had no recurrence of symptoms following up during at least 4 months.Conclusion Doppler ultrasound is an effective tool to diagnose nutcracker syndrome before operation.Transposition of the left renal vein is a safe and effective surgical approach in the treatment of left renal vein nutcracker syndrome.