Renal autotransplant as a definitive treatment for nutcracker syndrome: A multicenter retrospective study.

IF 2.8 2区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Jennifer L Philip, Jessica Saben, Ece Meram, Tracy Steinberg, Kate Lauer, John Malamon, Elizabeth Pomfret, Trevor Nydam, David P Foley, Thomas Pshak
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引用次数: 0

Abstract

Objective: Nutcracker syndrome is a rare condition that involves mechanical compression of the left renal vein, leading to chronic and debilitating left flank pain. The etiology of the pain is misdiagnosed frequently, and patients usually require long-term opioid use to manage their pain. Multiple therapeutic options for nutcracker syndrome have been described in the literature but the reports are limited by small numbers of patients, and the lack of convincing data demonstrating consistently improved outcomes. Here we report the largest series to date of patients undergoing renal autotransplantation for the treatment of nutcracker syndrome.

Methods: We performed a multicenter retrospective cohort review of patients 105 patients with nutcracker syndrome who underwent renal autotransplantation as a primary or salvage therapy.

Results: During the overall study period, 93.1% of patients treated with autotransplantation had durable, complete flank pain relief at 12 months with both open and robotic surgical approach. After autotransplantation, a statistically significant decrease in the percentage of patients using opioids from 48.6% to 17.0% was demonstrated at 12 months. In those patients using opioids before autotransplantation, a statistically significant decrease in morphine milligram equivalents was demonstrated from an alarming 68.9 ± 15.0 per day to 25.0 ± 11.02 morphine milligram equivalents per day.

Conclusions: Our findings suggest that renal autotransplantation, as a primary treatment or a salvage treatment, in patients with nutcracker syndrome provides durable pain relief and a marked decrease in chronic opioid use regardless of surgical approach.

将肾脏自体移植作为胡桃夹子综合征的最终治疗方法:一项多中心回顾性研究
目的:胡桃夹子综合征是一种罕见的病症,它是指左肾静脉受到机械性压迫,从而导致慢性、令人衰弱的左侧腹痛。疼痛的病因经常被误诊,患者通常需要长期使用阿片类药物来控制疼痛。文献中描述了胡桃夹综合征的多种治疗方案,但由于患者人数较少,且缺乏令人信服的数据证明疗效持续改善,因此这些报告受到了限制。在此,我们报告了迄今为止接受肾脏自身移植手术治疗胡桃夹综合征的最大规模患者系列:我们对 105 名接受肾脏自身移植作为主要或挽救疗法的努特克雷综合征患者进行了多中心回顾性队列研究:结果:在整个研究期间,93.1%的接受自身移植治疗的患者在12个月后通过开放式手术和机器人手术方法完全缓解了侧腹疼痛。接受自体移植手术后,12 个月时使用阿片类药物的患者比例从 48.6% 降至 17.0%,差异有统计学意义。在接受自身肾移植前使用阿片类药物的患者中,吗啡毫克当量(MME)从每天68.9±15.0毫克下降到每天25.0±11.02毫克,下降幅度在统计学上有显著性:我们的研究结果表明,无论采用哪种手术方法,肾脏自身移植作为胡桃夹综合征患者的主要治疗方法或挽救治疗方法,都能持久缓解疼痛,并明显减少阿片类药物的长期使用。
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来源期刊
Journal of vascular surgery. Venous and lymphatic disorders
Journal of vascular surgery. Venous and lymphatic disorders SURGERYPERIPHERAL VASCULAR DISEASE&n-PERIPHERAL VASCULAR DISEASE
CiteScore
6.30
自引率
18.80%
发文量
328
审稿时长
71 days
期刊介绍: Journal of Vascular Surgery: Venous and Lymphatic Disorders is one of a series of specialist journals launched by the Journal of Vascular Surgery. It aims to be the premier international Journal of medical, endovascular and surgical management of venous and lymphatic disorders. It publishes high quality clinical, research, case reports, techniques, and practice manuscripts related to all aspects of venous and lymphatic disorders, including malformations and wound care, with an emphasis on the practicing clinician. The journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with vascular and lymphatic disorders. As the official publication of The Society for Vascular Surgery and the American Venous Forum, the Journal will publish, after peer review, selected papers presented at the annual meeting of these organizations and affiliated vascular societies, as well as original articles from members and non-members.
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