ABSTRACT
Objective To investigate the Laparoscopic management for Nutcraker Syndrome(NCS) with resection of fibrous ring and placing extravascular stent.Methods This was a retrospective analysis of clinical data and treatment process of cases from March 2010 to February 2015 in urology department,affiliated hospital of Guizhou medical university.Five cases with NCS,4 males and 1 female;age were 28-40 years,mean age was 35 years,all cases were afflicted with gross hematuria and flank pain,the history of gross hematuria were 6-72 months.3 cases were afflicted with proteinuria.Duplex ultrasound scanning before surgery revealed the compressed left renal vein (LRV) between the aorta and the superior mesenteric artery(SMA),with peak velocity 110-132 cm/s,an average of 121 cm/s.The flow velocity of LRV in the renal hilum were 18-25 cm/s,an average of 21 cm/s.CT scanning showed that the stricture segment diameter of LRV were 1.2-2.5 mm,an average of 1.8 mm;and the max diameter of proximal dilatation of the LRV in renal hilum were 8.3-15.2 mm,an average of 10.1 mm.The ratio between the dilated segment inner diameter and the stricture segment were 3.4-9.5.Bleeding from the left ureteral orifice was detected by cystoscopy in 3 cases.5 cases were treated by resection of fibrous ring and placing extravascular stent with Laparoscopic management,and the average length of extravascular stent was 4.0 cm.Results The operation was successful in the 5 cases.The average operation time was 83 min.The average blood loss was 65 ml.Hematuria gradually reduce 5-6 days and resolved 7-20 days after surgery in 5 patients.Proteinuria was disappeared successful 2 weeks after surgery in 3 patients.There was no recurrence at 8-24 months' follow-up.3 days after surgery Doppler ultrasound showed the stricture segment diameter of LRV were 3.8-5.6 mm,an average of 4.9 mm;the ratio between the dilated segment inner diameter and the stricture segment decreased were 1.1-2.0,an average of 1.6;the peak velocity of compressed LRV were 25-45 cm/s,an average of 34 cm/s.6 months after surgery,CTA result showed no LRV compression in the aortomesenteric region;the max diameter of LRV in renal hilum were 7.9-9.8 mm and 6.0-8.8 mm in the aortomesenteric region of LRV.Conclusion Etiology of NCS exist a fibrous ring around the left renal vein outflow of the inferior vena cava besides the commonly anatomic extrinsic compression on the LRV as it crosses between the superior mesenteric artery and the aorta.The Laparoscopic management for NCS with resection of fibrous ring and placing extravascular stent is an effective minimally invasive treatment.
ABSTRACT
Objective To summarize the clinical experience in rigid ureteroscopy for the treatment of acute obstructive renal failure. Methods From June 2005 to April 2008,totally 127 patients with acute obstructive renal failure were treated by rigid ureteroscopy in the emergency of our hospital. Using EWSL or Holmium laser,the calculi were broken into pieces smaller than 2 mm in diameter. Larger pieces were removed with clamps. Double-J stent was indwelled after the operation. Results In this series,2 patients were converted to open surgery because of failure to insert the ureteroscope owning to ureteral stenosis. In the rest of the cases,the ureteroscopy was succeeded in 151 of the 178 sides (84.8%); and the obstruction was released with double-J stent indwelling in 169 sides. The mean operation time was 34 min (16-57 min). During the operation,2 cases developed ureteral perforation and 3 had hypovolemic shock. In 17 cases (18 sides),the calculi moved back into the renal pelvis,and thus received a second EWSL. Totally 65 cases (51.2%,65/127) developed gross hematuria,and were cured spontaneously in 1 to 3 days. Conclusions Rigid ureteroscopy can be the first choice for acute obstructive renal failure,for the procedure is safe and minimally invasive,leading to quick recovery. It is applicable to bilateral ureteral obstruction.