CAJ | 학술논문

目的探讨腹腔镜下左肾静脉外支架固定术治疗左肾静脉压迫综合征的临床疗效.方法左肾静脉压迫综合征患者5例.男4例,女1例.年龄20～35岁,平均25岁.肉眼血尿3例,活动后加重,合并蛋白尿1例;左腰酸痛伴左精索静脉曲张2例.术前彩色多普勒超声及CT三维血管重建均提示左肾静脉压迫明显.扩张段与受压段直径比值均＞3.膀胱镜检查3例可见左输尿管口喷血尿.5例均于全麻下行腹腔镜下左肾静脉受压段外支架固定术治疗,术中用人造血管固定于下腔静脉与生殖静脉之间形成血管外支架以克服左肾静脉受压.结果 5例手术均顺利完成.手术时间65～70 min,平均67 min.术中出血量10～15 ml,平均13 ml.术中术后无明显外科并发症,术后恢复顺利,术后5～6 d出院.肉眼血尿消失3例,左精索静脉曲张减轻2例.术后随访9～39个月,平均28个月,1例术前肉眼血尿、术后仍有轻微镜下血尿,4例尿常规检查正常.5例其余症状均消失,超声检查示左肾静脉血流通畅、受压现象消失.结论腹腔镜下左肾静脉外支架固定术采用人造血管环绕左肾静脉抵抗肠系膜上动脉压迫,是治疗左肾静脉压迫综合征的一种可供选择的微创技术,手术简单、方便、安全有效,创伤小、痛苦少、恢复快.
목적 탐토복강경하좌신정맥외지가고정술치료좌신정맥압박종합정적림상료효.방법 좌신정맥압박종합정환자5례.남4례,녀1례.년령20～35세,평균25세.육안혈뇨3례,활동후가중,합병단백뇨1례;좌요산통반좌정색정맥곡장2례.술전채색다보륵초성급CT삼유혈관중건균제시좌신정맥압박명현.확장단여수압단직경비치균＞3.방광경검사3례가견좌수뇨관구분혈뇨.5례균우전마하행복강경하좌신정맥수압단외지가고정술치료,술중용인조혈관고정우하강정맥여생식정맥지간형성혈관외지가이극복좌신정맥수압.결과 5례수술균순리완성.수술시간65～70 min,평균67 min.술중출혈량10～15 ml,평균13 ml.술중술후무명현외과병발증,술후회복순리,술후5～6 d출원.육안혈뇨소실3례,좌정색정맥곡장감경2례.술후수방9～39개월,평균28개월,1례술전육안혈뇨、술후잉유경미경하혈뇨,4례뇨상규검사정상.5례기여증상균소실,초성검사시좌신정맥혈류통창、수압현상소실.결론 복강경하좌신정맥외지가고정술채용인조혈관배요좌신정맥저항장계막상동맥압박,시치료좌신정맥압박종합정적일충가공선택적미창기술,수술간단、방편、안전유효,창상소、통고소、회복쾌.
Objective To report the experience in the use of laparoscopic extravascular stent for the treatment of the nutcracker syndrome. Methods Five patients (4 men and 1 woman) aged 20 to 35 years (mean 25) underwent laparoscopic extravascular stent of the left renal vein (LRV) for treatment of nutcracker syndrome associated with severe recurrent gross hematuria and left gonadal vein varices. All patients met the criteria for establishing the diagnosis of nutcracker syndrome. Ultrasonography, computed tomography, and magnetic resonance imaging revealed visible entrapment of the LRV between the superior mesenteric artery and aorta. Bleeding from the left ureteral orifice was detected by cystoscopy in 3 cases. An externally reinforced graft was selected to form an external stent around the LRV to relieve the compression. Results The mean operation time was 67 min (65-70min). No complications occurred during surgery. The postoperative follow-up was 9 to 39 months (mean 28). Total relief was achieved in 4 men without a relapse of symptoms and abnormalities were not found in urine tests. There was partial relief for the female patient due to microscopic hematuria after the operation. In all the 5 cases, Color Doppler ultrasonography showed that the blood outflow was smooth, the inner diameter and flow velocity of the aortomesenteric portion of the LRV were both decreased, and the gonadal vein varices had diminished in diameter. Conclusions The laparoscopic extravgscular stent of the renal vein could be a feasible approach for re-establishing free renal venous outflow in patients with nutcracker syndrome. This slightly invasive treatment could eliminate the symptoms of the condition.