腹腔镜下左肾静脉外支架固定术治疗左肾静脉压迫综合征的临床分析

Laparoscopic extravascular renal vein stent placement for nutcracker syndrome

目的探讨腹腔镜下左肾静脉外支架固定术治疗左肾静脉压迫综合征的临床疗效。方法左肾静脉压迫综合征患者5例。男4例，女1例。年龄20～35岁，平均25岁。肉眼血尿3例，活动后加重，合并蛋白尿1例；左腰酸痛伴左精索静脉曲张2例。术前彩色多普勒超声及CT三维血管重建均提示左肾静脉压迫明显。扩张段与受压段直径比值均〉3。膀胱镜检查3例可见左输尿管VI喷血尿。5例均于全麻下行腹腔镜下左肾静脉受压段外支架固定术治疗，术中用人造血管固定于下腔静脉与生殖静脉之间形成血管外支架以克服左肾静脉受压。结果5例手术均顺利完成。手术时间65～70min，平均67min。术中出血量10～15ml，平均13ml。术中术后无明显外科并发症，术后恢复顺利，术后5～6d出院。肉眼血尿消失3例，左精索静脉曲张减轻2例。术后随访9～39个月，平均28个月，1例术前肉眼血尿、术后仍有轻微镜下血尿，4例尿常规检查正常。5例其余症状均消失，超声检查示左肾静脉血流通畅、受压现象消失。结论腹腔镜下左肾静脉外支架固定术采用人造血管环绕左肾静脉抵抗肠系膜上动脉压迫，是治疗左肾静脉压迫综合征的一种可供选择的微创技术，手术简单、方便、安全有效，创伤小、痛苦少、恢复快。

Objective To report the experience in the use of laparoscopic extravascular stent for the treatment of the nutcracker syndrome. Methods Five patients （4 men and 1 woman） aged 20 to 35 years （mean 25） underwent laparoscopic extravascular stent of the left renal vein （LRV） for treat ment of nutcracker syndrome associated with severe recurrent gross hematuria and left gonadal vein varices. All patients met the criteria for establishing the diagnosis of nutcracker syndrome. Ultrasonography, computed tomography, and magnetic resonance imaging revealed visible entrapment of the LRV between the superior mesenterie artery and aorta. Bleeding from the left ureteral orifice was detected by cystoscopy in 3 cases. An externally reinforced graft was selected to form an external stent around the LRV to relieve the compression. Results The mean operation time was 67 min （65 70 min）. No complications occurred during surgery. The postoperative follow-up was 9 to 39 months （mean 28）. Total relief was achieved in 4 men without a relapse of symptoms and abnormalities were not found in urine tests. There was partial relief for the female patient due to microscopic hematuria after the operation. In all the 5 cases, Color Doppler ultrasonography showed that the blood outflow was smooth, the inner diameter and flow velocity of the aortomesenteric portion of the LRV were both decreased, and the gonadal vein varices had diminished in diameter. Conclusions The laparoscopic extravascular stent of the renal vein could be a feasible approach for reestablishing free renal venous outflow in patients with nutcracker syndrome. This slightly invasive treatment could eliminate the symptoms of the condition.