“胡桃夹”现象在正常儿童人群中的百分比及临床意义

发布时间：2018-03-13 13:00

本文选题：“胡桃夹”现象　切入点：儿童　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:探讨“胡桃夹”现象在正常儿童人群中出现的百分比及临床意义。材料与方法:回顾性分析2012年1月至2016年3月在重庆医科大学附属儿童医院放射科因非肾脏相关疾病行腹部CT血管造影(Computed Tomographic Angiography,CTA)检查的住院儿童影像及临床资料,共246例,男131例,女115例;年龄范围1月~13.0岁,平均年龄(4.94±3.48)岁;所有儿童均除外左肾及左肾静脉相关疾病与变异,除外腹膜后占位性病变,尿常规检查未见异常。按年龄分为7组:婴儿期(1月~1.0岁)为1组,其它1.0~13.0岁儿童以两岁为间隔分为6组。在CTA图像上,同时具备以下两个条件时判定为“胡桃夹”现象:腹主动脉与肠系膜上动脉之间的夹角(Aortomesenteric Angle,AMA)45°;左肾门部左肾静脉最宽处内径(D2)和腹主动脉与肠系膜上动脉间左肾静脉受压处内径(D1)之比大于或等于3。分析“胡桃夹”现象在正常儿童人群出现的百分比,以及AMA的变化。结果:246例中,34例(13.82%)出现“胡桃夹”现象,婴儿组出现百分比为0%,余下各组百分比依次为5.77%(3/52),12.20%(5/41),16.67%(8/48),18.75%(6/32),23.81%(5/21),28.00%(7/25),各年龄组“胡桃夹”现象出现的百分比存在显著的等级趋势性增高差异(χ2=13.879,P0.01),年龄越大出现百分比相对越高,而AMA随年龄的增大逐渐变小。结论:“胡桃夹”现象在正常儿童人群出现的百分比约为13.82%,随年龄有增长趋势,该现象可以作为一种正常的解剖变异出现在一部分正常儿童中,正确认识这一现象可避免将其过度诊断为“胡桃夹”综合征。
[Abstract]:Objective: to explore the percentage and clinical significance of "Nutcracker" phenomenon in normal children. Materials and methods: retrospective analysis was conducted from January 2012 to March 2016 in the Department of Radiology, Children's Hospital affiliated to Chongqing Medical University. The imaging and clinical data of hospitalized children with non-renal related diseases were examined by computed Tomographic angiography. A total of 246 cases, male 131 and female 115, were aged from January to January, with an average age of 4.94 卤3.48 years. All children were excluded from left kidney and left renal vein related diseases and variations, except for retroperitoneal space occupying lesions. Urine routine examination was not abnormal. It was divided into 7 groups according to age: group 1 in infancy (January, 1. 0 years old), and 6 groups in other children aged 1. 0 to 13. 0 years old. On CTA images, 6 groups were divided into 6 groups. "Nutcracker" is determined as a "nutcracker" phenomenon when the following two conditions are satisfied: the angle between the abdominal aorta and the superior mesenteric artery, Aortomesenteric Anglean AMA-45 掳; the left renal vein at the widest point of the left hilar; and the left kidney rest between the abdominal aorta and the superior mesenteric artery, and between the abdominal aorta and the superior mesenteric artery. The ratio of diameter D _ 1 to D _ 1 was greater than or equal to 3. The percentage of "nutcracker" phenomenon in normal children was analyzed. And the change of AMA. Results the "nutcracker" phenomenon appeared in 34 out of 246cases. The percent in the infant group was 0, and the percentage for the rest of the group was 5.77 / 52 / 12.20 and 5 / 45 / 41, 16.67 / 848 / 18.75% respectively. There was a significant trend increase in the percentage of "walnut clamp" in all age groups (蠂 ~ 2 / 13.879), the higher the percentage, the higher the relative percentage of the "walnut clamp" in all age groups (蠂 ~ 2 / 13.879, P 0.01). Conclusion: the percentage of "nutcracker" in normal children is about 13.82, and it has an increasing trend with age. It can be seen as a normal anatomical variation in some normal children. The correct understanding of this phenomenon can avoid the over-diagnosis of Nutcracker syndrome.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R816.92;R726.9

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