胡桃夹现象的多层螺旋CT血管成像诊断

Nutcracker phenomenon: a new diagnosis method of multislice computed tomography angiography

目的:探讨引起血尿的胡桃夹现象发病机制及其诊断新方法。方法:应用多层螺旋CT动态扫描,采用不同的图像后处理技术进行血管成像,比较确诊胡桃夹现象患者4例与正常对照者10例的血管显示情况及解剖变异。结果:CT血管成像发现胡桃夹现象患者左侧肾静脉在腹主动脉与肠系膜上动脉之间明显受压,其夹角平均为(39.3±4.3)°,而正常对照组的夹角平均为(90±10)°。在肾静脉水平肠系膜上动脉与腹主动脉之间的直线距离,正常对照组平均为(12±1.8)mm,而胡桃夹现象患者平均为(3.1±0.2)mm,两组比较差异有显著性意义(P<0.05)。结论:多层螺旋CT扫描行肾静脉及周围血管重建证实引起血尿的胡桃夹现象的主要发病机制是左侧肾静脉受压。多层螺旋CT三维血管成像在胡桃夹现象临床诊断中具有潜在的应用价值,具有立体直观、无创简便优点,可作为胡桃夹现象临床筛查的一种常规确诊手段。

Objective ：To explore the pathogenesis of the nutcracker phenomenon and to describe its new diagnostic techniques. Methods：Computerized tomographic Angiography （CTA） was used to compare the anatomical relations of the left renal vein with the aorta and the superior mesenteric artery in patients with the nutcracker phenomenon and in a control group of 10 healthy kidney donors. Results： CTA examine showed the angles between the superior mescnteric artery and the aorta were （39.3 ± 4.3 ） ° in the patient group and （90 ± 10） ° in the control group respectively（ P 〈 0.05 ）. The distance between the superior mesenteric artery and the aorta at the level of the left renal vein was （ 12 ± 1.8 ） mm in the control group and （ 3.1 ± 0.2） mm in the patient group respectively （P 〈 0.05）. Conclusion：Reconstruction imaging of renal vein by means of CTA revealed that patients with he nutcracker phenomenon due to compression of the left renal vein between the abdominal aorta and the superior mesenteric artery and, therefore, might be a useful alternative imaging technique instead of conventional examinations.