左肾静脉支架植入治疗胡桃夹综合征

Left renal vein stent implantation for nutcracker syndrome

目的探讨介入治疗胡桃夹综合征的效果。方法 4例胡桃夹综合征男性患者,年龄17～26岁,临床表现为肉眼血尿和镜下蛋白尿;B超示左肾静脉受压,狭窄处血流加快,CT示腹主动脉与肠系膜上动脉夹角处(<30°)左肾静脉狭窄。对所有患者均采取介入治疗,行左肾静脉造影并测压后,经股静脉或颈静脉途径于左肾静脉植入长60mm、直径16～18mm自膨式血管支架。结果对4例患者介入治疗均取得成功。术后支架形态良好,血管受压现象消失,左肾静脉狭窄两端压力差由10～16mmHg下降为0～3mmHg,患者临床症状明显改善。随访6～12个月,除1例出现一过性镜下血尿外,余3例未见其他临床症状。结论采用介入方法治疗胡桃夹综合征具有微创、安全、治疗效果好的优点,对部分患者可替代手术治疗。

Objective To investigate the effectiveness of interventional therapy for nutcracker syndrome. Methods Four male patients were clinically diagnosed as nutcracker syndrome whose age ranged from 17 to 26 years old. The clinical fea- tures were characterized by hematuria and microscopic proteinuria. Ultrasound showed that blood flow in the stenostic seg- ment of the left renal vein was at high speed. CT scan clearly displayed that the angle of abdominal aorta and superior mes- enteric artery was less than 30~, and left renal vein was compressed by the arteries. After angiography and pressure meas- urement, left renal vein stent implantation was performed trans-femoral or jugular vein. Results Technical success was a- chieved in all patients. Left renal vein blood flow speed and pressure of patients became normal. Pressure difference of left renal artery stenosis descended from 10--16 mmHg to 0--3 mmHg. The clinical symptoms improved subsequently. During the follow-up of 6--12 months, the patients showed no symptom except 1 case having transient microscopic hematuria. Conclusion Interventional treatment is mini-invasive, safe and effective for nutcracker syndrome, and can be regarded as an alternative to surgical operation in some patients.