21例成年人胡桃夹综合征临床诊治分析

目的：探讨胡桃夹综合征（NCS）在成年患者中的临床表现、诊断及治疗特点。方法：回顾性分析四川大学华西医院泌尿外科2001年2月至2008年11月期间收治入院的21例胡桃夹综合征患者的临床病历资料。结果：21例患者男性15例,女性6例。以血尿为最主要的症状,其中19例（90.48%）为肉眼血尿,2例（9.52%）为显微镜下血尿。17例（80.95%）患者尿中正常形态红细胞≥85%,11例（52.38%）患者尿蛋白呈阳性,9例（42.86%）患者彩超发现平卧位左肾静脉最宽处内径（a）与最窄处内径（b）比值均数为4.5±2.4,直立位a/b均数为8.1±2.6。15例（71.43%）患者CT呈现左肾静脉受压表现,8例（38.09%）患者膀胱镜检见左侧输尿管口喷血。7例（33.33%）行左肾静脉下移—下腔静脉端侧吻合术,平均血管阻断时间23±5.54min,血尿、蛋白尿在术后消失,其余14例（66.67%）行保守治疗,获得随访的5例患者中有3例血尿消失,2例患者仍有无症状性血尿和蛋白尿。结论：尿红细胞形态、肾血管彩色超声、增强CT、核磁共振（MRI）及膀胱镜检查对胡桃夹综合征的诊断具有重要价值,左肾静脉下移—下腔静脉端侧吻合术治疗胡桃夹综合征效果明确,术后并发症少。

The Clinical Treatment and Diagnosis Analysis of 21 Cases of Nutcracker Syndrome in Adult Patients

Objective： To study the clinical manifestation, diagnosis and treatment of nutcracker syndrome in adult patients. Methods： Twenty-one cases of nutcracker syndrome in the Department of Urology of West China Hospital of Sichuan University from February 2001 to November 2008 were included, and the clinical documents were retrospectively analyzed. Results： All 21 cases of patients （15 male and 6 female） had hematuria as the most important symptoms, 19 patients （90.48%） had gross hematuria, and 2 patients（9.52%） had microscopic hematuria. Urinary protein was positive in 11 patients （52.38%）, urinary red cell morphology showed ≥85% isomorphic red blood cells in 17 patients （80. 95%）. Ultrasonography showed that the mean ratio between maximum diameter （a） and the narrowest diameter （b） was 4. 5 i 2.4 at supine position, and 8.1±2.6 at Upright position in 9 cases （42.86%）. Computed tomography （CT） showed compression of left renal vein in 15 patients （71.43%）. Cystoscopy showed left urethral orifice spurting blood in 8 patients （38. 09%）. Left renal vein transposition was underwented in 7 patients （33.33%）, gross hematuria was disappeared after surgery, and the time of clamping ol the renal artery was 23±5.54 minutes. Conservative treatment was underwented in the other 14 patients （66.67%）, but only 5 patients were followed up, and hematuria disappeared in 3 patients and remain in 2 patients. Conclusion： Urinary cytology, Ultrasonography, CT, MRI and cystoscopy are valuable in diagnosis of nutcracker syndrome. Left renal vein transposition is an efficient surgical approach with an acceptable risk of complications.