三维超声动态观察移植肾体积变化及其临床意义

Consecutive volumemetry of transplant kidney with three dimensional ultrasound and its clinical significance

目的:探讨三维超声观察移植肾的体积变化及其临床意义。方法:利用三维超声体元模型法重建移植肾进行体积测量,对9例移植肾进行了动态观察,随访期1年。同时利用二维超声椭圆体积法计算肾脏的体积;利用多普勒超声在移植肾不同部位采样测量阻力指数(RI)和波动指数(PI)。比较几项指标的变化情况及临床意义。结果:9例患者共发生排异反应7次。出现排异反应时,肾脏体积均增大,增大率为18%±10%,范围7%～36%,抗排异治疗后,肾脏体积复原,非排异反应期间,肾脏体积较稳定。三维体积测量较二维测量有更好的稳定性和重复性。移植肾早期,RI值均较高,以后逐渐降低,大约6个月后趋于稳定。结论:三维体元模型法体积测量能够较敏感地反映移植肾体积的变化,动态观察移植肾体积的变化有助于排异反应的诊断和抗排异疗效判定。

Objective To study the volume variation of allografted kidney and its clinical significance. Methods Nine transplanted kidneys were successfully followed up for more than one year. Consecutive volumemetries were made with three dimensional ultrasound at the time of 10d 1 3 6 9 and 12 months after operation and extra mesurements were done whenever necessary. Resistance indexRI and pulse indexPI of different part of the allografted kidney were also investigated consecutively. Results Seven acute rejections were ocurred during the observation period. During acute rejection the renal volume was increased by 18%±10% ranging from 7%～36%. After successful anti rejection treatment the volume restored its normal size. Kidney’s volume remains stable during non rejection period. Three dimensional ultrasound is superior to two dimensional ultrasound in term of accuracy and reproducibility of the volumemetry. RI kept a relatively high level at the early stage of renal transplatation and then dropped gradually and remained a relatively stable lower level after 6 months of operation. Conclusion Three dimensional ultrasound can detect subtle change in transplant renal volume and this makes three dimensional ultrasound useful in the process of acute rejection diagnosis and treatment.