生殖静脉压迫致输尿管梗阻二例报告并文献复习

Ureteral obstruction resulted from vena genitalis compression： two cases report and literatures review

目的 探讨生殖静脉压迫致输尿管梗阻的临床特点及诊治方法.方法 回顾性分析2013年2月收治的2例生殖静脉压迫致输尿管梗阻引起肾积水患者的临床资料,并结合文献复习讨论.2例患者均表现为腰部不适,影像学检查发现轻度肾积水,一例为左侧积水,另一例为双侧积水;CTU检查提示梗阻部位为第3～4腰椎水平.分别在全麻下行腹腔镜手术治疗左侧肾积水,术中探查见生殖静脉斜跨上段输尿管,并压迫输尿管造成上段输尿管、肾盂扩张积水,切除压迫输尿管处的生殖静脉,解除梗阻.结果 术后患者腰部不适症状均好转,随访3个月,手术侧肾积水缓解,其中术前为双侧积水患者手术侧积水较未手术侧明显好转.结论 生殖静脉压迫致输尿管梗阻术前诊断相对困难,影像学上表现为输尿管在第3～5腰椎水平的腰大肌边缘与生殖静脉交叉处出现梗阻现象,输尿管可向外移位,上段输尿管、肾盂扩张.腹腔镜手术切除同侧生殖静脉,恢复输尿管通畅,能取得良好的疗效.

Objective To discuss the clinical features and treatment of ureteral obstruction resulted from vena genitalis compression. Methods 2 cases of hydronephrosis resulted from vena genitalis com- pression were discussed retrospectively, and relevant literatures were reviewed. Both of the 2 patients presen- ting with mild loin pain, and imaging studies showed hydronephrosis. One patients presenting with left hydro- nephrosis, and the other showed bilateral hydronephrosis. Imaging study showed ureter obstruction at L3-L4 level. Laparoseopic surgery found vena genitalis crossing and compressing the upper part of the ureter, resul- ted the upper ureter and pelvis dilation. Laparoscopic excision of vena genitalis were performed on these two cases. Results These patients＇symptoms were relieved and hydronephrosis alleviated evidently 3 month af- ter surgery in follow-up. Conclusions Hydronephrosis resulted from vena genitalis compression is a rare clinical manifestation. Classical imaging presents with ureter obstruction at L3-L5 level, at which the vena genitalis crossing the museuli psoas major. Ureter migrates outwards and the upper ureter and pelvis dilate. Pre-operative diagnosis is difficulty, but laparoscopic resection of the vena genitalis to relieve the obstruction of the ureter is recommended.