Jeanneret Christina, Beier Konstantin, von Weymarn Alexander, Traber Jürg
1 Angiology, Med. University Hospital, Kantonsspital Baselland, Bruderholz, Switzerland.
2 Institute for Anatomy, Departement Biomedizin, Universität Basel, Switzerland.
Vasa. 2016;45(4):275-82. doi: 10.1024/0301-1526/a000538.
Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.
了解盆腔静脉、性腺静脉和肾静脉的解剖结构对于理解盆腔淤血综合征（PCS）和左肾静脉受压综合征（LRCS）（也称为胡桃夹综合征）很重要。LRCS与PCS以及外阴、阴道和阴部静脉曲张的存在有关。这两种综合征的诊断很困难，通常通过CT或静脉造影来实现。金标准是使用传统静脉造影测量静脉压力。PCS的定义为盆腔疼痛，站立时加重且持续超过6个月。LRCS患者可见左侧腰痛和微量血尿。多次怀孕的女性在大隐静脉交叉切除和剥脱术后发生盆腔引流和卵巢静脉反流导致静脉曲张复发的风险增加。治疗选择包括：保守治疗（甲羟孕酮）、介入治疗（卵巢静脉栓塞）或手术治疗（卵巢静脉夹闭）。需要进行对照前瞻性试验以找到最佳治疗方法。
