Xu Danfeng, Liu Yushan, Gao Yi, Zhang Lei, Wang Junkai, Che Jiangping, Zhu Youhua
Department of Urology, Changzheng Hospital, 415Rd, Fengyang, Shanghai, 200003, China.
J Med Case Rep. 2009 Oct 27;3:82. doi: 10.1186/1752-1947-3-82.
Nutcracker syndrome (NCS) is caused by a compression of the left renal vein between the aorta and the superior mesenteric artery (SMA). It results in left renal venous hypertension, and the subsequent development of venous varicosities of the renal pelvis, ureter, and gonadal vein.
A 21-year-old Chinese woman was admitted with a seven-month history of unilateral severe hematuria. On admission, she was identified as having nutcracker syndrome. The patient was treated with retroperitoneal laparoscopic donor nephrectomy and renal autotransplantation. The patient underwent retroperitoneal laparoscopic donor nephrectomy using a retroperitoneal three-port technique with ex vitro autograft repair and subsequent renal autotransplantation into the iliac fossa. In order to shorten the hot ischemia time and improve the patient's cosmetic outcome, a minor oblique incision in the left, lower quadrant was prepared in advance of the laparoscopic donor nephrectomy for use as a site for the autograft to be procured through the retroperitoneal space and as a transplant site for the autograft. Two days after the operation, the patient's symptoms subsided. Serum creatinine before and after the operation were 53 mmol/L and 55 mmol/L, respectively. The patient had normal renal function during a follow-up three months after the operation.
The treatment of nutcracker syndrome by retroperitoneal laparoscopic nephrectomy with ex vitro repair and autotransplantation is a simpler and less invasive procedure than open surgery. Moreover, a minor incision on the left hypogastrium can shorten the autograft's hot ischemic time and improve patients' cosmetic outcomes, especially in young women.
胡桃夹综合征（NCS）是由于左肾静脉在腹主动脉和肠系膜上动脉（SMA）之间受到压迫所致。它导致左肾静脉高压，继而引起肾盂、输尿管和性腺静脉的静脉曲张。
一名21岁的中国女性因单侧严重血尿7个月入院。入院时，她被诊断为胡桃夹综合征。患者接受了后腹腔镜供肾切除术和自体肾移植术。患者采用后腹腔镜三孔技术进行后腹腔镜供肾切除术，同时进行体外自体移植修复，随后将肾脏自体移植至髂窝。为了缩短热缺血时间并改善患者的美观效果，在进行后腹腔镜供肾切除术之前，预先在左下腹做一个小斜切口，作为通过腹膜后间隙获取自体移植肾的部位以及自体移植肾的移植部位。术后两天，患者症状缓解。术前和术后的血清肌酐分别为53 mmol/L和55 mmol/L。术后三个月随访期间，患者肾功能正常。
后腹腔镜肾切除术联合体外修复及自体移植治疗胡桃夹综合征是一种比开放手术更简单、侵入性更小的手术方法。此外，左下腹的小切口可以缩短自体移植肾的热缺血时间并改善患者的美观效果，尤其对于年轻女性。
