彩色多普勒超声在移植肾动脉狭窄介入治疗前的应用价值

Applied value of color Doppler flow imaging before the interventional treatment for transplant renal artery stenosis

目的 评价彩色多普勒血流显像 (CDFI)在移植肾动脉狭窄患者进行血管成形术 (PTRA)和支架植入术 (PTRAS)治疗前的应用价值。方法 CDFI以主肾动脉峰值流速 (Vp)≥ 2 0 0cm /s ,肾内段动脉峰速加速度 (Ac)≤ 15 0cm /s2 为诊断肾动脉狭窄量化标准 ,对 410例肾移植患者进行筛选检查并对 11例行介入治疗的移植肾动脉狭窄者进一步确定狭窄部位和类型。结果 CDFI筛选诊断出肾动脉狭窄 48例 ( 11.7% ) ,其中 2 1例行肾动脉造影数字减影 (DSA )检查 ,均示肾动脉内径狭窄 >5 0 % ,证实CDFI诊断符合率 10 0 % ,阳性预测值10 0 %。 11例介入治疗的移植肾动脉狭窄者吻合口狭窄 8例 ,其中 4例为成角狭窄 ,供肾动脉狭窄 3例 ,CDFI对狭窄部位、类型判断符合率 90 .9%。结论 CDFI是对移植肾动脉狭窄介入治疗前进行筛选诊断的首选方法 ;CDFI对狭窄类型、部位的确定 ,可为介入治疗方案的选择提供重要依据。

Objective To assess the application value of color Doppler flow imaging (CDFI) before the percutaneous transluminal renal angioplasty (PTRA) and percutaneous transluminal renal partery stenting (PTRAS) for patients with transplant renal artery stenosis.Methods The quantitative CDFI diagnostic criteria for transplant renal artery stenosis were the peek velocity of main renal artery (Vp)≥200 cm/s,and the acceleration of the intrarenal segmental artery (Ac)≤150 cm/s 2.Four hundred and ten patients after kidney transplantation were detected by CDFI,of which 11 cases who needed interventional treatment underwent further detection to determine the stenostic site and type.Results Of the 48 cases of transplant renal stenosis screened by CDFI,21 cases took DSA examination and all showed an over 50% stenosis of the renal artery diameter.This confirmed that the diagnostic accurate ratio of CDFI was 100%,and so was the positive predicting ratio.There were 8 cases with anastomotic stenosis of which 4 cases with anglic stenosis and 3 cases with donor renal artery stenosis.The diagnostic accurate ratio for the stenositic site and type with CDFI was 90.9% .Conclusions CDFI is a reliable first choice method of screening diagosis for transplant renal artery stenosis before interventional treatment.The determination of stenostic site and type by CDFI provides important imformations for the choice of interventional treatment,ensures the success of interventional treatments,declines the complications incidence,and improves the near and far effects of interventional treatment.