3D打印支架治疗胡桃夹综合征合并IgA肾病的疗效观察

Efficacy of 3D printed extravascular stent in the treatment of nutcracker syndrome complicated with IgA nephropathy

目的观察3D打印血管外支架治疗胡桃夹综合征合并IgA肾病的疗效。方法回顾性分析2017年5月—2021年9月在空军军医大学唐都医院接受左肾静脉3D打印血管外支架植入术的19例胡桃夹综合征合并IgA肾病患者的资料,通过配对样本的统计学方法,分别对照术前、术后的影像学与临床检验结果,分析比较胡桃夹综合征合并不同Lee氏分级IgA肾病的治疗情况。结果随访数据显示19例患者术后至最新随访或随访结束影像学结果均呈现稳定。其中Lee氏分级Ⅱ级以下的16例患者肉眼血尿与蛋白尿症状均明显改善;此外,Lee氏分级Ⅲ级的3例患者虽然尿红细胞定量、24 h尿蛋白定量较术前也明显好转,但依然出现明显的肉眼血尿与蛋白尿,故需实施肾内科干预。结论3D打印血管外支架治疗胡桃夹综合征合并IgA肾病安全、有效,不同的Lee氏分级或可引导制定更加个性化的治疗方案。

Objective To observe the efficacy of 3D printed extravascular stent in the treatment of nutcracker syndrome(NCS)complicated with IgA nephropathy(IgAN).Methods Clinical data of 19 NCS cases complicated with IgAN treated with left renal vein 3D printed extravascular stent implantation in our hospital during May.2017 and Sep.2021 were retrospectively analyzed.With paired samples,the preoperative and postoperative imaging and clinical test results were compared to analyze the efficacy in the trentment of NCS with different Lee's pathological grades of IgAN.Results The imaging results of all 19 patients were stable until the latest or the end of follow-up.The gross hematuria and proteinuria symptoms of 16 patients with Lee's pathological grade belowⅡwere significantly improved.In the 3 patients of Lee's pathological gradeⅢ,although the urine red blood cell quantification and 24-hour urine protein quantification were significantly improved,there were still obvious gross hematuria and proteinuria,so nephrology intervention had to be started.Conclusion 3D printed extravascular stent is safe and effective in the treatment of NCS complicated with IgAN,and Lee's pathological grade may guide the formulation of more personalized treatment plans.