超声诊断腹主动脉后型左肾静脉的临床应用价值

Clinical value of ultrasonography in the diagnosis of left renal vein behind abdominal aorta

目的初步评价超声诊断腹主动脉后型左肾静脉的临床应用价值。方法回顾性分析2013年—2018年华中科技大学同济医学院附属协和医院超声诊断的腹主动脉后型左肾静脉患者的超声图像,收集并分析患者的一般资料、临床症状、超声图像等临床资料。结果共完成左肾静脉超声检查3519例,其中16例(0.45%)诊断为腹主动脉后型左肾静脉,其中男5例,女11例。所有患者均因尿常规隐血阳性就诊,其中合并左腰部不适等其他症状者共7例。超声均为首选检查方法。16例患者中,15例为完全腹主动脉后型即Ⅰ型,其中左肾静脉受压共13例,另有2例完全腹主动脉后型左肾静脉未见受压。16例中1例为环主动脉型即Ⅲ型,两支均有受压。结论当临床怀疑"胡桃夹"现象,要求对左肾静脉做相应评估时,超声可作为左肾静脉检查的首选方法。超声可较清楚显示大部分患者左肾静脉走行,判断左肾静脉有无变异、有无受压。超声对Ⅰ型的敏感性最高,不易漏、误诊;Ⅲ型易漏诊,而Ⅱ型及Ⅳ型超声不易检出,可能与超声显像的局限性有关。

Objective The purpose of our study was to assess the clinical value of ultrasound in the diagnosis of retroaortic left renal vein(RLRV)behind abdominal aorta.Methods The ultrasound images of patients with RLRV diagnosed by ultrasound in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from 2013 to 2018 were retrospectively analyzed.The general information,clinical symptoms,ultrasound images and other clinical data of the patients were collected and analyzed.Results RLRV was detected in 16(0.46%)cases of the 3519 patients from 2013 to 2018 using ultrasonography,and the male to female ratio was 11 to 5.All patients presented with hematuria,including 7 patients with other symptoms,such as left flank pain.Ultrasound were firstly performed in all patients.Of the 16 patients,15(93.75%)cases were of complete retroaortic typeⅠ,including 13(81.25%)cases with left renal vein compression and 2(12.5%)cases with complete retroaortic type without left renal vein compression.In 16 cases,1 case(6.25%)was typeⅢ,with compression of both branches.Conclusions Ultrasound may be the preferred method for the left renal vein examination when a clinical suspicion of Nutcracker syndrome is required.Ultrasound can clearly show the left renal vein in most patients,to determine whether the left renal vein is mutated or compressed.Ultrasound has the highest sensitivity for detecting the typeⅠ,which is not easy to misdiagnose.However,typeⅢis easy to misdiagnosis.Whereas the typeⅡand typeⅣis difficult to detect using ultrasound,which may be related to the limitations of ultrasound imaging.