CAJ | 학술논문

目的探讨生殖静脉压迫致输尿管梗阻的临床特点及诊治方法.方法回顾性分析2013年2月收治的2例生殖静脉压迫致输尿管梗阻引起肾积水患者的临床资料,并结合文献复习讨论.2例患者均表现为腰部不适,影像学检查发现轻度肾积水,一例为左侧积水,另一例为双侧积水;CTU检查提示梗阻部位为第3～4腰椎水平.分别在全麻下行腹腔镜手术治疗左侧肾积水,术中探查见生殖静脉斜跨上段输尿管,并压迫输尿管造成上段输尿管、肾盂扩张积水,切除压迫输尿管处的生殖静脉,解除梗阻.结果术后患者腰部不适症状均好转,随访3个月,手术侧肾积水缓解,其中术前为双侧积水患者手术侧积水较未手术侧明显好转.结论生殖静脉压迫致输尿管梗阻术前诊断相对困难,影像学上表现为输尿管在第3～5腰椎水平的腰大肌边缘与生殖静脉交叉处出现梗阻现象,输尿管可向外移位,上段输尿管、肾盂扩张.腹腔镜手术切除同侧生殖静脉,恢复输尿管通畅,能取得良好的疗效.
목적 탐토생식정맥압박치수뇨관경조적림상특점급진치방법.방법 회고성분석2013년2월수치적2례생식정맥압박치수뇨관경조인기신적수환자적림상자료,병결합문헌복습토론.2례환자균표현위요부불괄,영상학검사발현경도신적수,일례위좌측적수,령일례위쌍측적수;CTU검사제시경조부위위제3～4요추수평.분별재전마하행복강경수술치료좌측신적수,술중탐사견생식정맥사과상단수뇨관,병압박수뇨관조성상단수뇨관、신우확장적수,절제압박수뇨관처적생식정맥,해제경조.결과 술후환자요부불괄증상균호전,수방3개월,수술측신적수완해,기중술전위쌍측적수환자수술측적수교미수술측명현호전.결론 생식정맥압박치수뇨관경조술전진단상대곤난,영상학상표현위수뇨관재제3～5요추수평적요대기변연여생식정맥교차처출현경조현상,수뇨관가향외이위,상단수뇨관、신우확장.복강경수술절제동측생식정맥,회복수뇨관통창,능취득량호적료효.
Objective To discuss the clinical features and treatment of ureteral obstruction resulted from vena genitalis compression.Methods 2 cases of hydronephrosis resulted from vena genitalis compression were discussed retrospectively,and relevant literatures were reviewed.Both of the 2 patients presenting with mild loin pain,and imaging studies showed hydronephrosis.One patients presenting with left hydronephrosis,and the other showed bilateral hydronephrosis.Imaging study showed ureter obstruction at L3-L4 level.Laparoscopic surgery found vena genitalis crossing and compressing the upper part of the ureter,resulted the upper ureter and pelvis dilation.Laparoscopic excision of vena genitalis were performed on these two cases.Results These patients'symptoms were relieved and hydronephrosis alleviated evidently 3 month after surgery in follow-up.Conclusions Hydronephrosis resulted from vena genitalis compression is a rare clinical manifestation.Classical imaging presents with ureter obstruction at L3-L5 level,at which the vena genitalis crossing the musculi psoas major.Ureter migrates outwards and the upper ureter and pelvis dilate.Pre-operative diagnosis is difficulty,but laparoscopic resection of the vena genitalis to relieve the obstruction of the ureter is recommended.