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CT Evaluation of the Findings of Nutcracker Syndrome in Patients with Bladder Cancer after Radical Cystectomy and Ileal Neobladder Formation: A Correlation with Hematuria

근치적 방광적출 후 회장 신방광형성술을 시행받은 방광암 환자의 컴퓨터단층촬영: 호두까기 증후군 소견의 분석 및 혈뇨와의 관계

  • Hae Min Shin (Department of Radiology, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University) ;
  • Joongyub Lee (Department of Preventive Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Dong Hyeon Lee (Department of Radiology Urology, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University) ;
  • Seung Hyup Kim (Department of Radiology, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University)
  • 신해민 (이화여자대학교 의과대학 이대목동병원 영상의학과) ;
  • 이중엽 (서울대학교 의과대학 서울대학교병원 예방의학과) ;
  • 이동현 (이화여자대학교 의과대학 이대목동병원 비뇨의학과) ;
  • 김승협 (이화여자대학교 의과대학 이대목동병원 영상의학과)
  • Received : 2022.02.01
  • Accepted : 2022.07.28
  • Published : 2023.03.01

Abstract

Purpose Patients with bladder cancer may show hematuria after radical cystectomy with ileal neobladder formation, causing anxiety regarding tumor recurrence. Here, we aim to show that the nutcracker syndrome (NCS) can be a cause of hematuria post-operation, and is a common, rather than a rare syndrome. Materials and Methods A retrospective review of contrast-enhanced abdominopelvic CT (CE-APCT) and urine analysis (UA) findings of 255 patients with bladder cancer who underwent radical cystectomy and ileal neobladder formation between 2011 and 2016 was performed. In the CE-APCT review, the left renal vein flow patterns were evaluated to determine the presence of NCS findings. In the UA review, patients were classified according to the percentage of UA tests with positive hematuria among the total number of UA tests. Results CT findings of NCS were present in 31.9% of the 135 patients. In the positive hematuria group, there were 26% more patients with NCS findings than those without. Conclusion NCS findings are prevalent even for bladder cancer patients after surgery, and there is a strong correlation between NCS findings and hematuria. Furthermore, the prevalence of NCS findings is much higher than urinary tract recurrence after the surgery.

목적 근치적 방광적출 후 회장 신방광형성술을 시행 받은 방광암 환자는 수술 후 혈뇨를 보일 수 있는데, 이는 종양 재발에 대한 불안을 유발할 수 있다. 그러나 종양 재발뿐 아니라 호두까기 증후군이 수술 후 혈뇨의 원인이 될 수 있으며, 이는 빈번한 증후군일 수 있음을 증명하려고 한다. 대상과 방법 2011년부터 2016년까지 근치적방광적출 후 회장 신방광형성술을 시행 받은 255명의 방광암 환자를 대상으로 조영증강 복부골반 컴퓨터단층촬영과 소변검사 소견을 후향적으로 분석하였다. 컴퓨터단층촬영에서 호두까기 증후군 소견의 유무는 좌신정맥 흐름 패턴을 평가하여 판단하였다. 소변분석에서는 총 소변검사에서 혈뇨가 양성인 비율에 따라 환자를 분류하였다. 결과 컴퓨터단층촬영에서 호두까기 증후군 소견은 135명의 환자 중 31.9%에서 나타났다. 혈뇨 양성 그룹에서는 호두까기 증후군의 소견이 없는 환자보다 있는 환자가 26% 더 많았다. 결론 호두까기 증후군의 소견은 수술 후 방광암 환자에게 빈번하였으며, 호두까기 증후군 소견과 혈뇨 사이에는 유의미한 상관관계가 있었다. 또한 호두까기 증후군 소견의 유병률은 수술 후 요로의 종양 재발률보다 높았다.

Keywords

References

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