彩色多普勒超声在胰肾联合移植术后的应用价值

The value of color Doppler flow image in the simultaneous pancreas-kidney transplantation

目的探讨彩色多普勒超声(CDFI)在胰肾联合移植(SPK)术后的应用价值。方法用CDFI定期连续观测18例SPK患者术后移植胰腺及移植肾的声像图特征和动静脉血流变化,同时将移植胰腺与患者自身胰腺相比较。结果18例SPK患者术后早期移植胰腺均出现体积增大,形态饱满,内部回声减低,与自体胰腺相比较,差异有统计学意义(P<0.05);移植胰的胰头及胰尾部增大较明显,多在数10d至1个月后逐渐恢复正常。其中出现并发症5例(5/18,28%)。急性排斥反应2例(2/18,11%)。超声图像特征为:移植肾体积增大,实质增厚,各级动脉血流阻力指数(RI)增高(均在0.80～1.0之间);移植胰腺周围出现局限性积液暗区,移植物腹腔干动脉RI波动在0.67～0.78之间。1例移植胰胰腺炎声像图特征为:移植胰腺体积明显增大,内部实质回声不均,胰周积液不断增多,移植物腹腔干动脉RI<0.7,移植肾声像图正常。CDFI诊断右侧髂外静脉及属支部分栓塞1例(1/18,6%);移植物腹腔干动脉血栓栓塞1例(1/18,6%)。结论CDFI在胰肾联合移植中具有重要的应用价值。

Objective To evaluate the value of color Doppler flow image （CDFI） in the simultaneous pancreas-kidney （SPK） transplantation. Methods By using CDFI, the acoustic image features and blood flow changes of the pancreas grafts and kidney grafts were observed regularly in 18 patients subject to SPK and the pancreas grafts were compared with the self pancreases. Results Complications occurred in 5 cases （5/18, 28 %）. In 2 cases of acute rejection （2/18, 11%）, the features of the acoustic images included the enlarged volume, thickened parenchyma and increased flood flow resistance index of all grade arteries in kidney grafts （0. 80-1.0）. Around the transplanted pancreas, hydrops area was displayed resistance index of the celiac trunk artery fluctuated within 0. 67-0. 78. The acoustic image features of one case of transplanted pancreatitis were as follows： the transplanted pancreas was obviously enlarged, the internal echo of the parenchyma was uneven, the hydrops around the transplanted pancreas was increased continuously, the RI of celiac trunk artery in the grafts was less than 0. 7 and the acoustic images of the kidney grafts were normal. By using CDFI, embolism in right external iliac vein and its tributary occurred in one case and abdominal trunk arterial thrombus of the grafts in one case respectively. Conclusion CDFI may play an important role in the SPK transplantation.