Kamimura Yoshiho, Fukuda Mamoru, Egawa Masayuki, Kosugi Ikuko, Ohtake Hiroshi
Department of Urology, Tonami General Hospital.
Nihon Hinyokika Gakkai Zasshi. 2011 Jul;102(4):633-7. doi: 10.5980/jpnjurol.102.633.
A 20 year-old man presented to emergency room with severe left-sided flank pain. Urinalysis showed hematuria and he was referred to the urology department. KUB, DIP and retrograde pyelography (RP) revealed multiple renal stones, left hydronephrosis (grade 2) and ureteropelvic junction obstruction (UPJO). Abdominal CT revealed shortened nutcracker distance and renal angiography showed left renal vein hypertension. From these findings, diagnosis of nutcracker syndrome was made. Transposition of the left renal vein, dismembered pyeloplasty and left pyelolithotomy were performed simultaneously. 2 months after the procedure, his symptom and hematuria disappeared. 3 months after the procedure, DIP revealed improvement of hydronephrosis (grade 1) and CT showed elongation of nutcracker distance. In 12 months follow-up, there was no recurrence of symptom and hydonephrosis. To the best our knowledge, there has been no report of UPJO associated with nutcracker syndrome and the simultaneous treatment for the both diseases.
一名20岁男性因左侧剧烈腰痛就诊于急诊室。尿液分析显示血尿，随后他被转诊至泌尿外科。腹部平片（KUB）、排泄性尿路造影（DIP）和逆行肾盂造影（RP）显示多发肾结石、左肾积水（2级）和肾盂输尿管连接处梗阻（UPJO）。腹部CT显示胡桃夹距离缩短，肾血管造影显示左肾静脉高压。根据这些发现，诊断为胡桃夹综合征。同时进行了左肾静脉转位、离断性肾盂成形术和左肾盂切开取石术。术后2个月，他的症状和血尿消失。术后3个月，DIP显示肾积水改善（1级），CT显示胡桃夹距离延长。在12个月的随访中，症状和肾积水均未复发。据我们所知，尚无关于UPJO合并胡桃夹综合征以及同时治疗这两种疾病的报道。
