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目的:探讨胡桃夹综合征(NCS)在成年患者中的临床表现、诊断及治疗特点。方法:回顾性分析四川大学华西医院泌尿外科2001年2月至2008年11月期间收治入院的21例胡桃夹综合征患者的临床病历资料。结果:21例患者男性15例,女性6例。以血尿为最主要的症状,其中19例(90.48%)为肉眼血尿,2例(9.52%)为显微镜下血尿。17例(80.95%)患者尿中正常形态红细胞≥85%,11例(52.38%)患者尿蛋白呈阳性,9例(42.86%)患者彩超发现平卧位左肾静脉最宽处内径(a)与最窄处内径(b)比值均数为4.5±2.4,直立位a/b均数为8.1±2.6。15例(71.43%)患者CT呈现左肾静脉受压表现,8例(38.09%)患者膀胱镜检见左侧输尿管口喷血。7例(33.33%)行左肾静脉下移—下腔静脉端侧吻合术,平均血管阻断时间23±5.54min,血尿、蛋白尿在术后消失,其余14例(66.67%)行保守治疗,获得随访的5例患者中有3例血尿消失,2例患者仍有无症状性血尿和蛋白尿。结论:尿红细胞形态、肾血管彩色超声、增强CT、核磁共振(MRI)及膀胱镜检查对胡桃夹综合征的诊断具有重要价值,左肾静脉下移—下腔静脉端侧吻合术治疗胡桃夹综合征效果明确,术后并发症少。
Objective: To investigate the clinical manifestations, diagnosis and treatment of nutcracker syndrome (NCS) in adult patients. Methods: The clinical records of 21 patients with Nutcracker Syndrome who admitted to hospital from February 2001 to November 2008 in Department of Urology, West China Hospital of Sichuan University were retrospectively analyzed. Results: There were 15 males and 6 females in 21 cases. Hematuria was the most common symptom, of which 19 (90.48%) were gross hematuria and 2 (9.52%) were microscopic hematuria. Of the 17 patients (80.95%), the urinary normal erythrocytes were more than 85%, while the urine samples of 11 patients (52.38%) were positive for urinary protein. The widest diameter of the left renal vein in the supine position was found by color Doppler ultrasound in 9 patients (42.86% The average ratio of a / b to the narrowest internal diameter was 4.5 ± 2.4, and the average a / b in the upright position was 8.1 ± 2.6.15 (71.43%). CT showed left renal vein compression in 8 patients (38.09%), Cystoscopy in patients with left ureteral orifice spurt. 7 cases (33.33%) underwent left anastomosis of the left renal vein - inferior vena cava anastomosis, the mean vascular occlusion time was 23 ± 5.54min, hematuria and proteinuria disappeared after operation, and the remaining 14 cases (66.67%) received conservative treatment Among the 5 patients who were followed, hematuria disappeared in 3 patients and asymptomatic hematuria and proteinuria in 2 patients. Conclusion: Urinary red blood cell morphology, color Doppler echocardiography, enhanced CT, magnetic resonance imaging (MRI) and cystoscopy are important for the diagnosis of nutcracker syndrome. Left renal vein down-inferior vena cava end-to-side anastomosis for Nutcracker Syndrome effect is clear, less postoperative complications.