彩色多普勒血流成像在胰肾联合移植术后的应用价值

Application of color Doppler flow imaging in simultaneous pancreas-kidney transplantation

目的探讨彩色多普勒血流成像(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10例胰肾联合移植术后患者的声像图特征和动静脉血流变化。结果10例胰肾联合移植术后患者早期均出现移植胰腺体积增大,形态饱满,内部回声减低,胰头及胰尾部增大较胰体部明显,差异存在显著性意义(P<0.05),多在十数天至1个月后恢复正常;其中2例术后移植肾体积增大,实质增厚,各级动脉血流阻力指数(RI)增高(均在0.71～1.0之间),移植胰腺周围出现局限性积液暗区,供体腹腔干动脉RI波动在0.67～0.78之间,CDFI提示急性排斥反应;1例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,供体腹腔干内动脉RI<0.70,移植肾声像图正常,CDFI诊断移植胰胰腺炎;另外,CDFI诊断右侧髂外静脉及属支部分栓塞1例;提示移植胰腺供体腹腔干动脉血栓栓塞1例。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 imaging （CDFI） in the simultaneous pancreas-kidney （SPK） transplantation. Methods Ten patients with SPK were evaluated by 2-D ultrasound image and CDFI. Results After transplantation, the transplanted pancreatic were hypertrophy in the early stage, meanwhile the plump shape and the decreased echogenicity of parenchyma in transplanted pancreas can be observed. And the size of pancreatic head and tail were enlarged more markedly than the body （P〈0.05） which can return to normal within ten days to one month. There were 2 patients experienced volume increased, substance thicken and all grade artery resistance index increased （0. 71- 1.0） in transplanted kidney and local liquid accumulation around the transplanted pancreas with donator artery resistance index ranged 0. 67-0. 78. The CDFI indicated allograft rejection. One patient was suffered from graft pancreatitis which the transplanted pancrea was markedly enlarged with donator artery resistance index below 0.70, meanwhile the transplanted kidney was normal. In another two patients： the one was found embolism in right external iliac vein and its tributary, the other one was shown arterial thrombus of donator celiac trunk by CDFI. Conclusion CDFI is a valuable tool to monitor the progress and complications of SPK.