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·腹部疾病·

多层螺旋CT(MSCT)在诊断胡桃夹综合征中的临床应用

作者:邱凯涛 黄德成 姚海东

所属单位:广东省中山市人民医院 放射影像中心 (广东 中山 528403)

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摘要

目的 分析和探讨多层螺旋CT(MSCT)在诊断胡桃夹综合征中的临床应用。方法 选择本院在2013年8月-2016年5月间 收治的60例胡桃夹综合征患者,并选取100例正常人为研究主体,分别是A组和B组。对比两组的MSCT影像结果,观 察A组LRV(左肾静脉)的MSCT表现和所伴随的征象;对比两组SMA(肠系膜上动脉)和AA(腹主动脉)间的夹角值、SMA、 AA与LRV中心层面部位间的距离,对比LRV于夹角受压部位的截面积(C1)、于近肾端最宽部位的截面积(C2),计算两 者比值,给予统计学分析。结果 A组中,5例呈现左肾增大现象,5例呈左肾灌注慢,14例呈侧枝循环建立,60例患 者均呈现出LRV的“漏斗样”病变。将两组的各项测量数据相比较,有差异,有统计学意义(P<0.05)。结论 MSCT 检查可以较为清晰的反映LRV的具体形态,并能准确测量各项数据,极为直观的判定LRV受压部位的变窄情况,且能 观察胡桃夹综合征的伴随征象,从而提高该病诊断的准确性。

Objective To analyze and discuss the clinical application of multi-slice spiral CT (MSCT) in the diagnosis of nutcracker syndrome. Methods 60 cases of nutcracker syndrome were selected from August, 2013 to May, 2016, and 100 normal subjects were selected as group A and group B respectively. The MSCT findings and the accompanying signs of LRV (left renal vein) in group A were compared with those of the two groups. The angle between SMA (superior mesenteric artery) and AA (abdominal aorta) AA and LRV, the ratio of the cross-sectional area (C1) of the LRV to the compression point of the proximal end of the LRV, and the cross-sectional area (C2) of the proximal part of the proximal renal region were calculated. The statistical analysis was performed. Results In group A, 5 cases showed left renal enlargement, 5 cases showed slow perfusion of left kidney, 14 cases showed collateral circulation, and 60 patients showed LRV funnel-like lesions. The data of the two groups were compared, there were differences, statistically significant (P<0.05). Conclusion MSCT examination can clearly reflect the specific morphology of LRV, and can accurately measure the data, extremely intuitive to determine the narrowing of the LRV compression site, and can observe the nutcracker syndrome associated with signs, thereby enhancing the disease Diagnostic accuracy.

【关键词】多层螺旋CT;胡桃夹综合征;左肾静脉;应用效果

【中图分类号】R692.16

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2017.02.022

前言

胡桃夹综合征是指LRV在流入下腔静脉的过程 中,需穿过AA和SMA,而二者间的夹角出现钳夹现 象,造成血液回流受阻,并使压力升高,进而引发一 系列临床症状[1]。主要的临床表现有蛋白尿、镜下血 尿、左腰痛和高血压等。传统的影像学诊断方法为双 向彩超,利用AA和SMA间夹角变化、肾静脉回流的速 度、肾静脉扩张段和狭窄段的直径比值等数据的测 量,进行全面诊断[2]。目前,多层螺旋CT成为该病的 主要诊断方法,本文旨在分析多层螺旋CT在诊断该病 中的临床应用,结果见下文。