左肾静脉压迫综合征29例报告

Left renal vein entrapment syndrome(report of 29 cases)

目的提高左肾静脉压迫综合征的诊治水平。方法回顾性地分析29例左肾静脉压迫综合征患者的临床资料。结果29例左肾静脉压迫综合征中表现血尿22例,蛋白尿5例,血尿合并蛋白尿2例。所有病例彩色多普勒超声示左肾静脉扩张段直径均为受压狭窄处的3倍以上,20例行MRA示左肾静脉受压。22例患者行保守治疗,随访观察病情发展,其中19例好转,3例加重。5例患者行左肾静脉内支架植入术,2例患者行肠系膜上动脉切断再植术,随访均症状消失,左肾静脉无明显受压。结论非肾小球性血尿或直立性蛋白尿为本病的主要临床表现。多普勒超声及MRA检查对本病具有重要的诊断价值。治疗上一般行保守治疗随访观察,对有肾功能损害或有并发症者行外科手术或介入治疗。

Objective To evaluate the diagnosis and treatment procedures of left renal vein entrapment syndrome. Methods 29 cases of left renal vein entrapment syndrome were retrospectively analyzed. Results 22 cases presented nonglomerular origin hematuria, 5 orthostatic proteinuria, 2 hematuria with proteinuria. Doppler sonography showed the anteroposterior（AP） diameter of left vein was 3 times as large as the diameter of the compressed vein. Magnetic resonance angiography （MRA） showed the left renal vein was compressed. 22 cases underwent conservative therapy. Follow up showed 19 cases improved and 3 worsened. Stent placement across the left renal vein was performed in 5 cases. Superior mesenteric arteriectomy and replantation was performed in 2 patients. Follow-up showed that the symptoms disappeared. Conclusion Hematuria or proteinuria is often found in left renal vein entrapment syndrome. Left renal vein entrapment syndrome can be diagnosed by Doppler sonography and MRA in the presence of hematuria or proteinuria. Follow-up must be taken carefully after diagnosis. Surgical and radiologic interventional procedures are effective in those who have renal dysfunction and complications.