左肾静脉压迫综合征65例误诊分析

Analysis of misdiagnosis of 65 cases of left renal vein entrapment syndrome

目的通过对临床上左肾静脉压迫综合征误诊分析以提高对左肾静脉压迫综合征认识，以减少误诊。方法对82例经过超声诊断为左肾静脉压迫综合征，65例曾被误诊，对此65例左肾静脉压迫综合征患者的临床资料进行分析。结果82例中仅有肾内科、儿科、泌尿外科三个科室11位医生申请开单检查，65例出现误诊。65例误诊病例中，男性30例，女性35例。年龄6～37岁，平均16．1岁。误诊时间2～42个月，中位时间7个月。有腰痛或腰酸者43例；有尿路刺激征者5例；尿检异常60例：有单纯蛋白尿者15例，有单纯血尿者21例，蛋白尿合并血尿24例。被误诊为慢性肾小球肾炎31例、隐匿性肾炎（无症状的蛋白尿和或血尿综合征）11例、急性肾炎综合征9例、腰肌劳损7例、尿路感染4例、泌尿系统结石1例、盆腔炎2例。合并肾小球肾炎16例中，之前均按肾小球肾炎（11例慢性肾炎，5例无症状的蛋白尿和或血尿综合征）诊治，12例尿检异常波动大，延迟3～16个月转诊医生后才诊断出合并左肾静脉压迫综合征。结论左肾静脉压迫综合征无特征性临床表现，大多数临床医师对本病认识不足，误诊率高，应提高临床医生对该病的认识，以减少误诊率。

Objective Through the analysis of misdiagnosis left renal vein entrapment syndrome,to improve the understanding and reduce the misdiagnosis of this disease.Methods 82 cases of left renal vein compression syndrome were diagnosed with ultrasound,65 cases were misdiagnosed.Clinical data of these 65 patients were analyzed.Results In 82 cases,only 11 doctors from renal department of internal medicine,pediatrics,department of urology wrote application for it.Among the 65 misdiagnosed cases,30 cases of male,female 35 cases.The age ranged from 6 to 37 years old,the average age was 16.1 years.The misdiagnosis duration ranged from 2 months to 42 months,the median time was 7 months.43 cases of low back pain or backache,urinary tract irritation in 5 cases,60 cases of abnormal urinalysis：a simple urinary protein in 15 cases,21 cases of simple hematuria,proteinuria,hematuria 24 cases. 31 cases were misdiagnosed as chronic glomerulonephritis,occult nephritis（asymptomatic proteinuria and hematuria syndrome）in 11 cases,acute nephritis comprehensive sign in 9 cases,7 cases of lumbar muscle strain,urinary tract infection in 4 cases,1 case of urinary tract stones,pelvic inflammatory disease in 2 cases.In the 16 cases complicated with glomerular nephritis,were treated as the glomerular nephritis before （11 cases of chronic nephritis,5 cases of asymptomatic proteinuria and hematuria syndrome）.12 cases of abnormal urine fluctuation,after a delay of 3 -16 months referral doctor was diagnosed with left renal vein entrapment syndrome.Conclusion The disease has no characteristic clinical manifestations,and most clinicians were short in understanding of the disease,so the misdiagnosis rate is high.The clinicians should improve the understanding of the disease,in order to reduce the misdiagnosis rate.