CAJ | 학술논문

目的：探讨多排螺旋CT诊断非夹角原因引起胡桃夹综合征的临床价值。方法回顾性分析临床怀疑胡桃夹综合征行多排螺旋CT肾脏检查的患者177例，其中阴性患者33例，阳性患者144例；通过测量肠系膜上动脉与腹主动脉夹角，肠系膜上动脉后方左肾静脉管径与扩张处管径及比值，以及左肾静脉解剖学形态，了解非夹角原因引起的胡桃夹综合征阳性患者的影像学表现。结果33例胡桃夹阴性患者中，肠系膜上动脉与腹主动脉夹角为(46.06±24.46)°；左肾静脉通过肠系膜上动脉后方时最窄处与扩张处管径的比值为2.11±0.76。144例诊断为胡桃夹阳性的患者，肠系膜上动脉与腹主动脉夹角为(23.10±9.63)°；左肾静脉通过肠系膜上动脉后方时最窄处与扩张段管径比值为3.83±1.24。阳性组与阴性组之间，角度与比值两者有显著差异(P<0.05)。其中有9例为非夹角原因引起的胡桃夹阳性：3例胰头钩突压迫；2例左肾静脉畸形；1例后胡桃夹；1例门静脉压迫；1例为左肾静脉迂曲盘绕肾动脉，引起左肾静脉管腔明显受压；1例为肠系膜上动脉与腹主动脉前后径过短，十二指肠与左肾静脉平行，左肾静脉管腔受压变窄，导致左肾静脉明显受压。结论多排螺旋 CT 血管重建能清楚显示左肾静脉受压原因及部位，有助于对非典型胡桃夹综合征的临床诊断。
목적：탐토다배라선CT진단비협각원인인기호도협종합정적림상개치。방법회고성분석림상부의호도협종합정행다배라선CT신장검사적환자177례，기중음성환자33례，양성환자144례；통과측량장계막상동맥여복주동맥협각，장계막상동맥후방좌신정맥관경여확장처관경급비치，이급좌신정맥해부학형태，료해비협각원인인기적호도협종합정양성환자적영상학표현。결과33례호도협음성환자중，장계막상동맥여복주동맥협각위(46.06±24.46)°；좌신정맥통과장계막상동맥후방시최착처여확장처관경적비치위2.11±0.76。144례진단위호도협양성적환자，장계막상동맥여복주동맥협각위(23.10±9.63)°；좌신정맥통과장계막상동맥후방시최착처여확장단관경비치위3.83±1.24。양성조여음성조지간，각도여비치량자유현저차이(P<0.05)。기중유9례위비협각원인인기적호도협양성：3례이두구돌압박；2례좌신정맥기형；1례후호도협；1례문정맥압박；1례위좌신정맥우곡반요신동맥，인기좌신정맥관강명현수압；1례위장계막상동맥여복주동맥전후경과단，십이지장여좌신정맥평행，좌신정맥관강수압변착，도치좌신정맥명현수압。결론다배라선 CT 혈관중건능청초현시좌신정맥수압원인급부위，유조우대비전형호도협종합정적림상진단。
Objective To evaluate the diagnostic value of multi-slice spiral CT for non-angle caused nutcracker syndrome(NCS). Methods A total of 177 cases of clinical suspected nutcracker syndrome patients recevied multi-slice spiral CT examination,,inclu-ding 33 patients with negative results,144 cases patients with positive results.The analysis was performed by measuring the angle between superior mesenteric artery(SMA)and the abdominal aorta(AA),and the ratio of the diameter of the narrowest and expan-sion in the left renal vein.Results Within 33 cases of nutcracker-negative patients,the angle of SMA and AA was (46.06 ± 24.46)°;the ratio was (2.11±0.76).144 cases was diagnosed as nutcracker-positive patients,the angle of SMA and AA was (23. 10±9.63)°;the ratio was (3.83±1.24).There was positive correlation between angle and ratio in NCS (P<0.0001).Among9 ca-ses of nutcracker syndrome caused by non-angle factors three were oppressed by the uncinate process pancreas,two cases were caused by the malformations of the left renal vein,one case was posterior nutcracker syndrome,one case was oppressed by portal veinOne case of pressured renal vein due to tortuosity renal vein coiled renal artery.One case of the left renal vein compression lumen narrowing,causing significant downward pressure on the left renal vein.Conclusion Spiral CT angiography reconstruction can clear-ly show the cause and the location of the left renal vein compression,which may provide helpful information in diagnosing nutcracker syndrome caused by non-angle factors.