Diagnosis And Treatment Of The Nutcracker Syndrome: 40 Cases Report

Background and purpose nutcracker syndrome (Nut-cracker syndrome, NCS) also known as the left renal vein compression syndrome refers to the left renal vein (LRV) through the superior mesenteric artery (SMA) and abdominal aorta (AO) of thethe angle between, due to smaller angle between oppression, which led to hematuria, proteinuria, reproductive varicose veins, left waist abdominal pain, headache, dizziness, loss of appetite, general fatigue, menstrual disorders and a series of clinical manifestations.This phenomenon in the 19th century,50 years have been mentioned in textbooks. Schepper first reported in 1972, left renal nutcracker syndrome caused by hemorrhage caused by a gradual clinical importance .Clinical examination along with a variety of technological development, the incidence of the disease gradually increased.Its diagnostic methods and processes as diverse as the people's understanding of the disease has gradually deepened, for the treatment of the disease are also different.This paper summarizes 2005.8 2009.12 hospital diagnosis and treatment of nutcracker syndrome in urology (NCP) in patients with clinical manifestations, laboratory test results, impact of information and results of operations of color Doppler ultrasound, and CTA in the nutcracker phenomenon in the diagnosis, preoperative preparation andsurgical options and left renal vein graft stent external fixation for treatment of the value and significance.Research Subjects and Methods To summarize 2005.8-2009.12 hospital urological diagnosis and treatment of patients with nutcracker syndrome in outpatient and inpatient data, select some healthy people to do negative control.Of the above subjects in accordance with strict inclusion and exclusion criteria opt-in this study.Of the cases included in this study in accordance with pre-designed forms from the outpatient and inpatient cases extracts.Pairs of color Doppler ultrasound and CTA measurements of superior mesenteric artery (SMA), abdominal aorta (AO), left renal vein (LRV) of the relationship between the results of statistical analysis to explore the color Doppler ultrasound, and CTA on the diagnosis of nutcracker syndrome; andcontrast to surgery and postoperative clinical and imaging to explore the left renal vein graft stent fixation external value and significance.Results August 2005～December 2009 this group of patients 11-39 years, mean 20 years of age; male and 24 cases, female 16 cases; naked eye and microscopic hematuria 34 cases; proteinuria in 19 cases; generalized fatigue, loss of appetite associated with a decrease of 4cases; left waist three cases of abdominal discomfort; four cases of women, excessive menstrual flow; men on the left varicocele in 13 cases.Physical examination body weight loss in 31 cases; the left kidney area pain in three cases of percussive; men in varying degrees on the left varicocele. Course of the disease in April-12 years, an average of 3 years.Laboratory tests were performed routine blood test, urine red blood cell morphology, electrolyte, blood glucose, coagulation function tests are within normal range; underwent color Doppler ultrasound showed no abnormal urinary tract.40 cases of patients with supine color Doppler ultrasound measurement of superior mesenteric artery (SMA) and abdominal aorta (AO) the angle between the (a) an average of 18.5°(7°-42°), normal (45-60°);left renal vein (LRV) compression Department diameter (dl) an average of 1.82mm (1.7-2.3mm); left renal vein distal diameter (near the kidney the door, d2) an average of 9.85mm (7.8-13.5mm);Left Renal Vein Entrapment at blood flow velocity (v1) an average of 1.33m/s (0.65m/s-1.91m/s); distal blood flow velocity (v2) an average of 0.26m/s (0.13ms-0.62m/s); distal left renal vein diameter and pressure at the ratio of d2/dl average diameter 3.2 (2.6-4.5), greater than 2 that is diagnosis.17 routine CTA of renal angiography showing SMA and the AO angle between (a) an average of 17.3°(7°-31°), normal (45-60°), significant compression of left renal vein, and 1 case of pancreatic head showDepartment of oppression left renal vein,1 case showed the superior mesenteric artery and its branches below the left renal vein of the fiber structure of oppression.14 cases of urinary plain film and IVP (KUB+IVP) showed no abnormality; 9 routine kidneys SCT scan showed no abnormal kidneys; 11 routine cystoscopy showed the left ureteral orifice spurting.38 cases according to color Doppler ultrasound and clinical manifestations that is diagnosed two cases of the line after CTA diagnosed with clinical manifestations.Among them,13 cases with surgical treatment is not for economic reasons, out-patient drug treatment conservative blood circulation; 12 cases of left renal vein graft stent external fixation treatment for various reasons I received no treatment.13 routine conservative treatment,4 cases were slightly improved symptoms of hematuria, proteinuria no improvement,1 case the symptoms disappeared; line outside the left renal vein graft stenting in 13 cases in 12 cases the symptoms disappeared completely, and 1 case symptomsimprovement, then OK, after left renal vein stent expansion within the symptoms are successfully recovered and discharged after four cases of color Doppler ultrasound and CTA referral investigations showed a normal left renal vein blood flow; I did not track the follow-up.Conclusion1, laboratory tests such as urine routine, red cell morphology examination, color Doppler ultrasound, CTA, cystoscopy, urinary plain film and IVP (KUB+IVP) and other tests, both for the nutcracker phenomenon diagnostic significance of higher value;2, color Doppler ultrasound can clearly see the left renal vein blood flow changes, suspected nutcracker phenomenon can be used as the first choice in patients with non-invasive examination;3, CTA can clearly see the superior mesenteric artery, abdominal aorta, left renal vein between the spatial structure can be a clear and objective observation to the specific location of oppression, repression level, clearly some variation of collateral blood vessels and oppressive situation, in order tosurgery provide a more detailed basis.4, left renal vein artificial blood vessel trauma outside the stent fixation, does not change the normal anatomic position, not involving major vascular anastomosis may be feasible, can be used as nutcracker syndrome, the ideal treatment for patients.