胡桃夹综合征2例报告并文献复习

Nutcracker syndrome ： report of 2 cases and review of the literature

目的探讨胡桃夹综合征的诊断及治疗。方法回顾性分析本院收治的2例胡桃夹综合征患者的临床资料，检索并复习国内外相关文献，2例患者均行腹腔镜下左。肾静脉人造血管外支架置入固定术，术中将直径约1cm长约4～5cm的带外支撑环的e—PTFE人造血管固定于下腔静脉与肾门之间的左肾静脉外，抵抗肠系膜上动脉的压迫，减轻肾静脉受压。结果2例患者手术顺利，分别于术后12d、13d肉眼血尿消失，术后1个月复查尿常规均提示：潜血（-），尿蛋白（-），术前伴有精索静脉曲张者，术后1个月复查症状明显减轻，随访6个月未复发。结论尿红细胞形态分析及计数、膀胱镜检查、彩超及CTA对于胡桃夹综合征诊断有重要价值，腹腔镜下左肾静脉血管外支架置入固定术治疗胡桃夹综合征疗效满意、并发症少、恢复快。

Objectives To study the diagnosis and treatment of nutcracker syndrome. Methods Retro- spective analysis of clinical data and treatment process of two cases of nutcracker syndrome in our hospital, and to re- view the relevant literature. Laparoscopic left renal vein extravascular stent fixation was underwent successfully in the two cases, and the e - PTFE extravascular was used to form an external stent around the LRV to relieve the compres- sion. Results The operation succeed in the two cases without surgical complications. The gross hematuria disap- peared respectively at 12,13 days after surgery, and the urinary routine was normal after one month. The varicocele in one patient was significant improved one month after surgery. No recurrence of symptoms occurred in the two patients followed up for six months. Conclusions Urinary erythrocytes morphology, cystoscopy, ultrasound and CTA are important for the diagnosis of nutcracker syndrome. Laparoscopic left renal vein extravascular stent fixation is an ef- fective surgery with an acceptable risk of complications.