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目的探讨左肾静脉压迫综合征的治疗方法。方法对20例左肾静脉压迫综合征患者的治疗进行回顾性分析。患者均行肾血管超声,磁共振血管造影和肾静脉造影检查明确诊断; 20例患者中行肠系膜上动脉移位术3例,行左肾静脉移位术2例,行左肾静脉支架植入术15例(16次)。结果(1)术后肾血管超声检查左肾静脉近端平卧位流速明显增快,站立15 min增快更明显,流速(131±54)cm／s;平卧位左肾静脉最宽和最窄处内径比为4．4±1．6,站立15 min后为8．1±1．7,均明显大于对照组;磁共振血管造影检查本组患者腹主动脉与肠系膜上动脉之间平均夹角为(30±5)度,对照组为(64±16)度;左肾静脉造影示左肾静脉和下腔静脉平均压差为(14±5) mmHg,支架植入后压差为(2．9±1．4)mmHg,差异有统计学意义(P<0．05)。(2)20例患者手术和介入治疗顺利,2例因腹膜后血肿和支架移位而再次手术和植入支架。20例患者随访6个月至6年, 18例患者术后尿检查均阴性。2例患者术后肉眼血尿消失,但活动后仍有镜下血尿。结论超声、MRA和左肾静脉造影可确诊左肾静脉压迫综合征。经股静脉左肾静脉支架植入术创伤小,是今后的治疗方向之一。
Objective To investigate the treatment of left renal vein compression syndrome. Methods Twenty patients with left renal vein compression syndrome were retrospectively analyzed. Patients underwent renal vascular ultrasound, magnetic resonance angiography and renal vein angiography confirmed diagnosis; 20 patients underwent superior mesenteric artery displacement in 3 cases, left renal vein shunt in 2 cases, left renal vein stent implantation 15 cases (16 times). Results (1) The postoperative renal vascular ultrasonography showed that the velocity of the proximal supine position of the left renal vein was significantly increased, and the speed of standing in the position of 15 min was faster (131 ± 54 cm / s) The ratio of the narrowest internal diameter was 4.4 ± 1.6 and 8.1 ± 1.7 after standing for 15 min, which were significantly greater than that of the control group. The MRI between the abdominal aorta and the superior mesenteric artery in this group was examined by MR angiography The average angle was (30 ± 5) degrees in the control group and (64 ± 16) degrees in the control group. The left renal vein and inferior vena cava had a mean pressure difference of (14 ± 5) mmHg after left renal vein angiography. (2.9 ± 1.4) mmHg, the difference was statistically significant (P <0.05). (2) Twenty patients underwent surgery and intervention successfully. Two patients underwent re-operation and stent implantation due to retroperitoneal hematoma and stent displacement. Twenty patients were followed up for 6 months to 6 years, 18 patients were negative urine examination. 2 patients after gross disappearance of hematuria, but still microscopic hematuria after the activity. Conclusion Ultrasound, MRA and left renal vein angiography can confirm left renal vein compression syndrome. The femoral vein left renal vein stent implantation trauma, is one of the future directions of treatment.