Shokeir A A, el-Diasty T A, Ghoneim M A
Urology and Nephrology Center, Mansoura University, Egypt.
Br J Urol. 1994 Aug;74(2):139-43. doi: 10.1111/j.1464-410x.1994.tb16574.x.
To study the pathophysiology of the nutcracker syndrome and to describe a new method of treatment.
Computerized tomography (CT) was used to compare the anatomical relations of the left renal vein with the aorta and the superior mesenteric artery in three patients with the nutcracker syndrome and in a control group of 12 healthy kidney donors.
Abnormal branching of the superior mesenteric artery from the aorta was identified as the cause of the nutcracker syndrome. Two patients were treated by autotransplantation of the left kidney, while the third refused surgery. In the treated patients haematuria ceased 4 and 6 weeks after surgery. Postoperative excretory urography and repeated isotopic studies revealed perfect configuration and function of the autotransplanted kidneys. The patients remain asymptomatic 6 and 12 months after surgery.
In patients with haematuria from the left kidney, angiographic CT must be considered before phlebography and pressure measurement of the left renal vein. If the diagnosis of the nutcracker syndrome is established, autotransplantation of the left kidney is a treatment alternative.
研究胡桃夹综合征的病理生理学并描述一种新的治疗方法。
采用计算机断层扫描（CT）对比3例胡桃夹综合征患者及12例健康肾供体对照组中左肾静脉与主动脉及肠系膜上动脉的解剖关系。
肠系膜上动脉自主动脉的异常分支被确定为胡桃夹综合征的病因。2例患者接受了左肾自体移植，而第3例拒绝手术。治疗的患者术后4周和6周血尿停止。术后排泄性尿路造影和重复的同位素检查显示自体移植肾的形态和功能良好。患者术后6个月和12个月无症状。
对于左肾血尿患者，在进行左肾静脉造影和压力测量之前必须考虑血管造影CT检查。如果确诊为胡桃夹综合征，左肾自体移植是一种治疗选择。
