移植肾静脉血栓的彩色多普勒超声诊断

Diagnostic value of color Doppler imaging for vein thrombosis of transplanted kidney

目的探讨移植肾静脉血栓的彩色多普勒超声诊断及鉴别诊断价值。方法采用HP2000型和IE33型彩色多普勒血流显像仪检查的肾移植患者876例,发现肾静脉血栓12例,并对照分析29例移植肾急性排异患者的超声诊断资料。结果12例肾静脉血栓患者彩色多普勒超声扫查显示:肾体积增大8例,肾窦回声分散,皮质界限不清10例,肾内静脉血流消失10例,PW呈特征性"倒M"形10例。29例重症急性排异中8例PW频谱出现舒张道路呈"V"形,肾内静脉血流充填良好。结论根据移植肾动静脉彩色多普勒血流改变和特征性的舒张期"倒M型"频谱,可以准确诊断移植肾静脉血栓并判断阻塞程度,虽然部分移植肾重度排异也可出现动脉血流的舒张期反转,但根据频谱形态和肾静脉血流充盈情况可以鉴别。

Objective To evaluate the diagnosis and differential diagnosis of vein thrombosis of transplanted kidney by color Doppler flow image. Methods The HP2000 and IE33 color Doppler flow imaging instrument was used to examine renal transplantation rejection, out of 876 patients, 12 patients were diagnosed renal vein thrombosis, and compared with 29 patients who were diagnosed acute renal allografi rejection. Results The 12 patients who were diagnosed renal vein thrombosis by color Doppler ultrasound were confirmed by pathology after allograft nephrectomy. Among them, 2 patients＇ main renal vein were obstructed incompletely, 7 patients＇ main renal vein were obstructed completely, with main renal artery palency,3 patients＇ main renal vein and artery were obstructed completely. Out of 29 acute severe renal transplantation rejection patients, 8 patients＇ PW spectrum showed reversed plateauing in early diastolic flow, as ＂V＂, segment renal veins were filled with blood flow. Conclusion According to the change of color Doppler blood flow image of transplanted kidney and the charaeteristic reversed ＂M＂ spectrum in early diastolic flow, vein thrombosis of transplanted kidney can be diagnosed accurately, furlhermore obstruction degree can be evaluate. Some of the acute severe renal transplantation rejection patients show reversed plateauing in early diastolic flow, but it can be differential diagnosed by spectrum morphology and blood filling of renal veins.