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目的探讨胡桃夹征(NCS)致左侧精索静脉曲张的诊断与治疗。方法回顾性分析12例胡桃夹征致左侧精索静脉曲张患者的临床资料。12例患者均采用左肾静脉造影+支架置入术治疗,术前、术后分别经彩色多普勒超声显像、选择性左肾静脉造影和(或)CT及MRI等检查。结果术后左肾静脉狭窄管腔扩张,血流恢复通畅。术前彩超显示左肾静脉狭窄段内径为1.1~2.9mm,平均(2.1±0.2)mm,术后为4.8~8.0mm,平均(6.5±0.6)mm(t=10.74,P=0.00);术前狭窄段血流速度为44~200cm/s,平均为(108.0±31.6)cm/s,术后22~49cm/s,平均为(33.3±4.15)cm/s(t=4.58,P=0.00),均有统计学意义。除1例患者术后复查仍表现为左精索静脉曲张外,其余患者精索静脉反流消失,5例血尿及2例蛋白尿患者术后1周复查尿常规正常。结论经皮左肾静脉支架置入术创伤小,住院时间短,近期效果明显,我们认为是目前治疗左肾静脉压迫综合征的首选方法,但远期效果有待观察。
Objective To investigate the diagnosis and treatment of left varicocele caused by nutcracker syndrome (NCS). Methods The clinical data of 12 patients with left varicocele caused by nutcracker were retrospectively analyzed. Twelve patients were treated with left renal vein angiography and stent implantation. Color Doppler ultrasound imaging, selective left renal vein angiography and / or CT and MRI were performed before and after operation respectively. Results Postoperative left renal vein stenosis lumen dilatation, blood flow recovered. Preoperative color Doppler ultrasound showed that the diameter of left renal vein stenosis ranged from 1.1 to 2.9 mm, averaged (2.1 ± 0.2) mm and postoperatively 4.8 to 8.0 mm (mean 6.5 ± 0.6 mm, t = 10.74, P = 0.00) The mean blood flow velocity was 44 ~ 200 cm / s in the anterior stenotic segment, with an average of 108.0 ± 31.6 cm / s and an average of 33.3 ± 4.15 cm / s at 22 ~ 49 cm / s (t = 4.58, P = 0.00 ), All with statistical significance. Except for one case, the patients still showed varicocele after the operation, the other patients had disappearance of varicocelectomy, five cases of hematuria and two cases of albuminuria. The urine routine was normal one week after operation. Conclusion Percutaneous left renal vein stent implantation is less invasive and has shorter hospital stay. The short-term effect is obvious. We believe it is the first choice for the treatment of left renal vein compression syndrome. However, the long-term effect remains to be seen.