学习目标 Learning Objectives
• 看过以后读者应该知道 The learner will be able to:
• 区别胡桃夹综合征和胡桃夹现象
Distinguish Nutcracker SYNDROME from Nutcracker PHENOMENON • 认识胡桃夹综合征的临床表现 Recognize the clinical presentation of Nutcracker Syndrome
• 认识超声、CT血管造影和血管造影胡桃夹综合征的表现
Recognize the ultrasound, CT angiography, and catheter angiography findings of Nutcracker Syndrome
• 了解胡桃夹综合征对于保守、外科手术和血管内治疗选择。
Understand the conservative, open surgical, and endovascular management options for Nutcracker Syndrome
静脉源性肾脏症状(历史上称为为Nutcracker syndrome/ Nutcracker phenomenon NCS/NCP)、、【K Ananthan 2017】  胡桃夹现象=NCP 被定义为一种解剖状况，其特征是外源性血管压迫左肾静脉，导致左肾静脉流出受阻 可以没症状？ 胡桃夹子综合征= NCS 定义应保留在有典型相关临床症状的情况下
胡桃夹现象（Nutcracker phenomenon）指左肾静脉回流入下腔静脉过程中在穿经由腹主动脉和肠系膜上动脉形成的夹角或腹主动脉与脊柱之间的间隙内受到挤压，常伴有左肾静脉血流速度的下降、受压处远端静脉的扩张。当胡桃夹现象引起血尿、蛋白尿和左腰腹痛等一系列临床症状时，称为胡桃夹综合征（Nutcracker syndrome）或左肾静脉压迫综合症（Left renal vein entrapment syndrome）。胡桃夹综合征年轻女性疾病处于早期，人到中年疾病进入晚期，或后期。
流行病学 Epidemiology
• Prevalence unknown due to lack of agreed-upon diagnostic criteria, but the condition is rare
• Age: Any, but highest incidence in 2nd-3rd decade
• Gender: Slight female predominance reported
Definitions： • Anterior Variant: Compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery (SMA)
• Posterior Variant: Compression of an aberrant retroaortic or circumaortic LRV between the aorta and thoracic spine
• Phenomenon- compression left renal vein between abdominal aorta and SMA
• Syndrome- symptoms secondary to nutcracker phenomenon
前胡桃夹现象
 后胡桃夹现象
后胡桃夹现象
胡桃夹现象是先天性的左肾静脉变异，
Nutcracker SYNDROME: The constellation of clinical symptoms and radiologic findings resulting from pathologic LRV compression/stenosis and resulting collateralization 胡桃夹子综合征:由病理性左肾静脉压迫/狭窄和侧支导致的一系列临床症状和影像学表现 左肾静脉高压（早期）： 血尿和后背疼痛 LRV Hypertension (early stage) Essential hematuria and flank pain
1. development of venous collateral vessels which increases venous capacitance（）
2. Competence of the venous valves of the OV or LV
3. Development of direct communication between the dilated venous sinuses and adjacent calyces
4. Flank pain/hemoturia/orthostatic proteinuria 左肾静脉高压（中期）：典型的盆腔充血综合症的症状
症状性盆腔充血综合征可通过多排CT决定是否左肾静脉变异和盆腔充血综合症的关系。研究显示左肾静脉变异可能是性症状盆腔静脉曲张的一个因素 先后关系：年轻女性主要是血尿和季肋部疼痛，中年出现典型的盆腔充血综合症的表现 胡桃夹综合症和盆腔充血综合症的关系 盆腔充血综合症卵巢静脉栓塞没有临床改善时，是不是需要考虑存在胡桃夹现象？ 考虑处理左肾静脉的治疗？
Illusion（错觉） of venous occlusion during Valsalva
临床发现取决于年龄 与左肾静脉充血有关的症状 - 早期阶段 症状与左性腺静脉和输尿管侧支循环相关 - 后期 例外 - 左肾静脉血栓 - 慢性肾脏病 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
