左肾静脉压迫综合征二例误诊分析并文献复习

Left Renal Vein Entrapment Syndrome: Analysis of Two Cases of Misdiagnosis and the Literature Review

目的分析左肾静脉压迫综合征的临床特点、诊治措施及误诊原因,提高对其认识,减少误漏诊。方法对我院近期收治曾误诊的左肾静脉压迫综合征2例的临床资料进行回顾分析。结果 2例分别因体检发现血尿1年、尿痛2 d及体检发现血尿3年、运动后血尿1 d就诊。2例均曾在外院误诊为隐匿性肾炎,入我院后行肾静脉彩色多普勒超声检查示左肾静脉扩张直径超过夹角段直径3倍以上,确诊为左肾静脉压迫综合征,例2同时合并左侧精索静脉曲张。2例均嘱增加体重,避免剧烈运动。随访6个月和3年左肾静脉压迫症状好转。结论左肾静脉压迫综合征临床表现无特异性,可表现为血尿和(或)蛋白尿、精索静脉曲张等,根据临床表现及彩色多普勒超声检查结果,并排除其他相关疾病可确诊。加强对其认识及综合全面细致分析病情可避免或减少左肾静脉压迫综合征误漏诊。

Objective To investigate the clinical characteristics, diagnosis and treatment measures, causes and pre-ventive measures for misdiagnosis of the left renal vein entrapment syndrome in order to raise awareness of the disease and pre-vent misdiagnosis. Methods Two recently misdiagnosed cases of the left renal vein entrapment syndrome admitted to our hos-pital were analyzed retrospectively. Results In one case, the patient had a 1-year history of hematuria, and sought for medi-cal care after two days of odynuria;in the other case, the patient had a 3-year history of hematuria, and sought for medical care due to hematuria one day after physical exercise. Both cases had been misdiagnosed as occult nephritis, and were diag-nosed as the left renal vein entrapment syndrome after the color doppler ultrasonography revealed that the ratio of left renal vein diameters distended to the narrowed portions exceeded 3∶ 1. The second case was also complicated by varicoceles on the left side. A 6-month and 3 year follow-up showed that symptoms were relieved after increasing body weight and avoiding vigorous physical activity. Conclusion The clinical characteristics of the left renal vein entrapment syndrome are not distinctive, but may be presented as hematuria and/or albuminuria, varicoceles, etc. Diagnoses can be made based on color doppler ultra-sonography results, clinical manifestations, and exclusion of other diseases. Improved knowledge and overall in-depth analysis may help to prevent or reduce misdiagnosis rate.