Prikaz izlečenja bolesnika sa obilnom hematurijom kod sindroma nutcracker primenom renokavalne reimplantacije

  • Igor Banzić Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
  • Nikola M Fatić
  • Siniša Pejkić Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
  • Lazar Davidović Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
  • Miloš Sladojević Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
  • Igor Končar Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP150401132B
Ključne reči: renal nutcracker syndrome||, ||nutcracker sindrom, renalni, diagnosis||, ||dijagnoza, vascular surgical procedures||, ||hirurgija, vaskularna, procedure, renal veins||, ||vv. renales, replantation||, ||replantacija, treatment outcome||, ||lečenje, ishod, serbia||, ||srbija,

Sažetak


Uvod. Nutcracker sindrom se definiše kao skup znakova i simptoma nastalih usled kompresije leve renalne vene u oštrom uglu koji formiraju aorta i gornja mezenterična arterija. Prikaz bolesnika. Bolesnica, stara 38 godina, sa obilnom, asimptomatskom i idiopatskom hematurijom primljena je na lečenje u Kliniku za vaskularnu i endovaskularnu hirurgiju Kliničkog centra Srbije u Beogradu. Hematurija je potvrđena cistoskopijom. Nađeno je da se radi o unilateralnoj hematuriji lokalizovanoj na levom ureteralnom orificijumu. Multidetektorskom kompjuterizovanom tomografijom (MDCT) angiografijom utvrđena je stenoza leve renalne vene, kao posledica kompresije, u uglu koji formiraju gornja mezenterična arterija i ventralna strana aorte. Uzimajući u obzir negativne nalaze o uzrocima hematurije, njen onesposabljavajući karakter i prethodno pomenuti nalaz MSCT angiografije, postavljena je sumnja na nutcracker sindrom kao i odluka o operativnom lečenju. Kako bi se leva renalana vena dislocirala iz aortomezenteričnih klešta, učinjena je njena reimplantacija udaljenije na venu kavu. Intraoperativni nalaz potvrdio je turbulentan tok u levoj renalnoj veni, torturozitet i našikanost njenih povezanih pritoka. Ovo je prvi primer nutcracker sindroma u Srbiji koji je izlečen renokavalnom reimplanatcijom. Zaključak. Rad ukazuje na adekvatnu vrednost renokavalne reimplantacije, kao otvorene hirurške tehnike, u lečenju obilne hematurije kod bolesnika sa nutcraker sindromom.

Biografija autora

Nikola M Fatić

Specijalizant vaskulerne hirurgije

Doktorant na Medicinkom fakultetu u Kragujevcu

Reference

Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D. Mesoaortic compression of the left renal vein (nutcracker syn-drome): Case reports and review of the literature. Ann Vasc Surg 2006; 20(1): 120−9.

Kim JY, Joh JH, Choi HY, Do YS, Shin SW, Kim DI. Transposi-tion of the left renal vein in nutcracker syndrome. Eur J Vasc Endovasc Surg 2006; 31(1): 80−2. 0

Rassi I, Khabbaz Z, Chelala D, Jebara VA. A new variant of the posterior nutcracker phenomenon. J Vasc Surg 2010; 51(5): 1279.

Ahmed K, Sampath R, Khan MS. Current trends in the diagnosis and management of renal nutcracker syndrome: A review. Eur J Vasc Endovasc Surg 2006; 31(4): 410−6.

Macmahon HE, Latorraca R. Essential renal hematuria. J Urol 1954; 71(6): 667−76.

Hohenfellner M, Steinbach F, Schultz-Lampel D, Schantzen W, Walter K, Cramer BM, et al. The nutcracker syndrome: new aspects of pathophysiology, diagnosis and treatment. J. Urol 1991; 146(3): 685−8.

Zhang H, Zhang N, Li M, Jin W, Pan S, Wang Z, et al. Treatment of six cases of left renal nutcracker phenomenon: Surgery and endografting. Chin Med J 2003; 116(11): 1782−4.

Shokeir AA, Diasty TA, Ghoneim MA. The nutcracker syn-drome: New methods of diagnosis and treatment. Br J Urol 1994; 74(2): 139−43.

Stewart BH, Reiman G. Left renal venous hypertension "nut-cracker" syndrome. Managed by direct renocaval reimplanta-tion. Urology 1982; 20(4): 365−9.

Scultetus AH, Villavicencio JL, Gillespie DL. The nutcracker syn-drome: its role in the pelvic venous disorders. J Vasc Surg 2001; 34(5): 812−9.

Neste MG, Narasimham DL, Belcher KK. Endovascular stent placement as a treatment for renal venous hypertension. J Vasc Interv Radiol 1996; 7(6): 859−61.

Park YB, Lim SH, Ahn JH, Kang E, Myung SC, Shim HJ, et al. Nutcracker syndrome: Intravascular stenting approach. Neph-rology, dialysis, transplantation 2000; 15(1): 99−101.

Wei S, Chen Z, Zhou M. Intravenous stent placement for treat-ment of the nutcracker syndrome. J Urol 2003; 170(5): 1934−5.

Segawa N, Azuma H, Iwamoto Y, Sakamoto T, Suzuki T, Ueda H, et al. Expandable metallic stent placement for nutcracker phe-nomenon. Urology 1999; 53(3): 631−3.

Barnes RW, Fleisher HL, Redman JF, Smith JW, Harshfield DL, Ferris EJ. Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): Repair by a new stenting pro-cedure. J Vasc Surg 1988; 8(4): 415−21.

Reed NR, Kalra M, Bower TC, Vrtiska TJ, Ricotta JJ, Gloviczki P. Left renal vein transposition for nutcracker syndrome. J Vasc Surg 2009; 49(2): 386−93.

Objavljeno
2017/03/14
Broj časopisa
Vol. 73 Br. 12 (2016)
Rubrika
Prikaz bolesnika