Barnes R W, Fleisher H L, Redman J F, Smith J W, Harshfield D L, Ferris E J
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock 72205.
J Vasc Surg. 1988 Oct;8(4):415-21. doi: 10.1067/mva.1988.avs0080415.
Compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta has been termed the nutcracker syndrome. Although often asymptomatic, this syndrome may result in varicocele, ovarian vein syndrome, and rarely LRV hypertension, pelviureteral varices, hematuria, and flank pain. Previous surgical approaches have included nephrectomy, variceal ligation, nephropexy, or renocaval reimplantation. We report a new LRV stenting procedure that provided relief for a young woman incapacitated by daily left flank pain and microscopic hematuria. Phlebography of the LRV revealed mesoaortic compression associated with a pressure gradient of 12 mm Hg and preferential outflow down large pelviureteral varices. At operation compression of the LRV was corrected with an external stent of reinforced polytetrafluoroethylene. The patient was asymptomatic and free of hematuria for 9 months after operation and follow-up phlebography documented normal renocaval flow, elimination of the pressure gradient, and reduction of the pelviureteral varices. This represents the first description in the vascular surgical literature of this venous compression syndrome, which has been recognized in previous urologic and radiologic reports reviewed herein. Vascular surgeons should be cognizant of the nutcracker syndrome, and we recommend this new stenting procedure as a more simple and physiologic therapy than previous approaches to this problem.
肠系膜上动脉与腹主动脉之间的左肾静脉（LRV）受压被称为胡桃夹综合征。尽管该综合征通常无症状，但可能导致精索静脉曲张、卵巢静脉综合征，极少情况下会引起左肾静脉高压、肾盂输尿管静脉曲张、血尿和侧腹痛。以往的手术方法包括肾切除术、曲张静脉结扎术、肾固定术或肾腔静脉再植术。我们报告了一种新的左肾静脉支架置入术，该手术为一名因每日左侧腹痛和镜下血尿而丧失劳动能力的年轻女性缓解了症状。左肾静脉静脉造影显示中主动脉受压，压力梯度为12毫米汞柱，且有大量肾盂输尿管静脉曲张导致的优先血流。手术中，用强化聚四氟乙烯外部支架纠正了左肾静脉受压情况。术后9个月，患者无症状且无血尿，随访静脉造影显示肾腔静脉血流正常，压力梯度消除，肾盂输尿管静脉曲张减轻。这是血管外科文献中对这种静脉受压综合征的首次描述，在本文回顾的以往泌尿外科和放射学报告中已有所认识。血管外科医生应认识到胡桃夹综合征，我们推荐这种新的支架置入术作为比以往处理该问题的方法更简单且符合生理的治疗手段。
