多层螺旋CT对胡桃夹综合征的诊断价值及临床意义

Evaluation of nutcracker syndrome and related anatomy by multislice spiral CT

目的利用多层螺旋CT探讨正常人及胡桃夹综合征(NCS)患者肠系膜上动脉(SMA)与腹主动脉(AA)相关解剖对左。肾静脉(LRV)的影响。方法选取经临床和相关检查诊断为NCS的10例(病例组)与29例正常。肾血管者(正常对照组)分别按性别分组和按年龄分组(≤40岁为Ⅰ组,>40岁为Ⅱ组),分别观察LRV及其属支的形态、走行位置以及与邻近结构的关系;矢状面或斜矢状面测量SMA与AA的夹角α、夹角问LRV横截面积S;横断面测量SMA和AA间隙内LRV管径D1与近肾侧LRV最大管径D2,并计算D2与D1的比值Q。结果 (1)病变组中LRV均明显扩张,4例合并十二指肠淤滞征,6例合并侧支循环形成;(2)病变组与正常组α的Q、S值分别为20.60±5.79、56.17±17.20;3.67±1.34、1.46±0.29;30.93±14.62. 92.92±39.93,两组差异有统计学意义(P<0.01);(3)正常对照组不同性别及不同年龄组中各测量值差异无统计学显著意义(P>0.05)。结论利用MSCT能精细测量SMA与AA夹角等相关解剖数据,能判断LRV狭窄的程度,为诊断和治疗NCS提供了一种新的无创性检查方法。

Objective To discuss the effect of the related anatomy of superior mesenteric artery （SMA） and abdominal aorta（AA） on left renal vein （LRV）in normal and nutcracker syndrome （NCS）using multisliee spiral computed tomography. Methods Ten patient with NCS confirmed by clinic and correlated examinations （patient group） and 29 subjects with normal kidneys and renal vessels （ control group） were retrospectively reviewed. The normal group was grouped according to sex and age （ below 40 year was I group and above 40 year was II group）. The anatomy, course and relationship to the adjacent structure of left renal vein（LRV） and its branches were observed. The angle（a） between SMA and AA, the cross section area （S）between SMA and AA at the level of LRV passing through the anyle. The caliber of the LRV through the angle （D1） and the largest caliber near the renal hilar（D2） were measured and the ratio （Q） of D2 to D1 was calculated. Results （1）In patient group all LRVs were compressed and showed dilatation, 4 of them combined with dodecadaetylon stasis and 6 of them with by pass circuit; （2）The value of a,Q,S in the patients group and the control group were ： 20. 60 ±5. 79,56. 17 ± 17.20;3.67 ± 1.34,1.46 ± 0. 29;30. 93 ± 14. 62, 92.92 ±39.93, the differences were significant between the two groups （P 〈0.01 ） ; （3） The differences in values of different sex and I , II age groups in the control group were not statistically significant （ P 〉 0. 05 ）. Conclusion The angle between SMA and AA and the related anatomy data could be well delineated on the MSCT, wieh provides a relative ideal noninvasive technique for diagnosis of NCS.