摘要目的 探讨采用3D打印制作个体化血管外支架行腹腔镜血管外支架植入术治疗胡桃夹综合征的安全性和有效性.方法 前瞻性收集我院2015年8月至2016年8月收治的胡桃夹综合征患者资料,术前均行彩色多普勒超声及CT检查,符合胡桃夹综合征诊断标准.根据患者术前检查数据设计防移位血管外支架数字模型,以钛合金为原料通过3D金属打印机打印血管外支架.患者均行腹腔镜血管外支架植入术,游离左肾静脉至下腔静脉处,将支架植入受压的左肾静脉周围.结果 本研究共10例患者,男9例,女1例.年龄(21.5±4.6)岁.伴有严重肉眼血尿4例,蛋白尿1例,左侧腰痛5例,左侧精索静脉曲张5例.术前超声检查示左肾静脉受压处直径为(1.57±0.25) mm;血流速度为(164.40 ±55.27) cm/s;肾门处左肾静脉直径为(8.70±1.59) mm,血流速度为(10.70±2.21)cm/s.手术均顺利完成,手术时间(75±11) min.术后平均住院时间7d.所有患者肉眼血尿、蛋白尿、左侧腰痛等症状在术后3～7d缓解.术后随访所有患者均无症状复发,支架位置稳定.术后12个月复查超声示左肾静脉肾门处直径为(8.23±1.90)mm,与术前比较明显变细(P＜0.01),血流速度为(21.20 ±3.88) cm/s,与术前比较明显加快(P＜0.01).结论 采用3D打印技术制作个体化的血管外支架,通过腹腔镜技术植入受压左肾静脉周围是一种微创、安全、有效治疗胡桃夹综合征的方法.

abstractsObjective To assess the safety and effectiveness of laparoscopic implantation of three-dimensional (3D)-printed extravascular stent for treatment of nutcracker syndrome (NCS).Methods The clinical data of NCS in our hospital were prospectively collected from August 2015 to August 2016.Doppler ultrasound and CT examination were performed before the operation of all the patients who were in line with the diagnostic criteria of NCS.The 3D model of extravascular stents with especial device to prevent migration was designed and was made by 3D metal printer with titanium alloy.The left renal vein(LRV) was exposed completely up to the inferior vena cava,then the stent was placed around the compressed LRV.Results 10 patients were enrolled in the study,including 9 males and 1 females,age (21.5 ±4.6) years.Among these patients,there were 4 cases with severe hematuria,1 case with proteinuria,5 cases with left lumbago,and 5 cases with left severe varicocele.The preoperative doppler ultrasound examination showed the diameter of the the compressed LRV was (1.57 ± 0.25) mm,and flow velocity was (164.40 ± 55.27) cm/s;the diameter of the LRV at the renal hilum was (8.7 ± 1.59) mm,and flow velocity was (10.70 ± 2.21) cm/s.The average operation time was (75 ± 11) min,and the average hospital stay after operation was 7 d.All symptoms were relieved at 3-7 d after operation.All patients were asymptomatic and all stents were stable after follow-up.At 12 months after surgery,the diameter of the LRV at the renal hilum was (8.23 ± 1.90) mm on doppler ultrasound,and there was significant decrease (P ＜ 0.01);the flow velocity was (21.20 ±3.88) cm/s,and there was significant increase (P ＜ 0.01).Conclusions Laparoscopic three-dimensional printed extravascular stent placement is a safe,effective and minimally invasive technique for treatment of NCS.