BMJ:看看是啥原因引起的间歇性血尿及左侧腰部疼痛-案例报道

2017-02-12 xing.T MedSci原创

位于主动脉和肠系膜上动脉之间的左侧肾静脉受压迫,导致静脉高压引起血尿、腰部疼痛。这种罕见的现象被称为胡桃夹综合征。对于尿路成像的超声、静脉尿路造影及膀胱镜检查正常的腰痛和血尿患者应该怀疑是否为胡桃夹综合征。

患者为一名68岁的女性,因间歇性血尿和左侧腰部疼痛6个月而就诊。

膀胱镜检查和肾脏超声检查的结果均为阴性。腹部和盆腔CT显示左侧性腺血管扩张(如图1所示)。


图1

位于主动脉和肠系膜上动脉之间的左侧肾静脉受压迫,导致静脉高压引起血尿、腰部疼痛。这种罕见的现象被称为胡桃夹综合征。对于尿路成像的超声、静脉尿路造影及膀胱镜检查正常的腰痛和血尿患者应该怀疑是否为胡桃夹综合征。

外科手术治疗包括左侧肾静脉移位或自体扩张支架的血管内治疗。如果没有严重的血尿相关贫血或盆腔剧烈疼痛,该病预后良好。

原始出处:


Miguel Angel Arrabal-Polo,et al.Intermittent haematuria and left flank pain. BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.i5391

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1955003, encodeId=b4fa1955003c6, content=<a href='/topic/show?id=732f9e265d7' target=_blank style='color:#2F92EE;'>#间歇性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97265, encryptionId=732f9e265d7, topicName=间歇性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0361487, createdName=花花1366, createdTime=Mon Oct 23 20:53:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848230, encodeId=28551848230b3, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Mon Oct 30 04:53:00 CST 2017, time=2017-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1446938, encodeId=392e144693890, content=<a href='/topic/show?id=259d8906e50' target=_blank style='color:#2F92EE;'>#血尿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89067, encryptionId=259d8906e50, topicName=血尿)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Tue Feb 14 02:53:00 CST 2017, time=2017-02-14, status=1, ipAttribution=)]
    2017-10-30 gaoxiaoe
  3. [GetPortalCommentsPageByObjectIdResponse(id=1955003, encodeId=b4fa1955003c6, content=<a href='/topic/show?id=732f9e265d7' target=_blank style='color:#2F92EE;'>#间歇性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97265, encryptionId=732f9e265d7, topicName=间歇性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0361487, createdName=花花1366, createdTime=Mon Oct 23 20:53:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848230, encodeId=28551848230b3, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Mon Oct 30 04:53:00 CST 2017, time=2017-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1446938, encodeId=392e144693890, content=<a href='/topic/show?id=259d8906e50' target=_blank style='color:#2F92EE;'>#血尿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89067, encryptionId=259d8906e50, topicName=血尿)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Tue Feb 14 02:53:00 CST 2017, time=2017-02-14, status=1, ipAttribution=)]
    2017-02-14 quxin068