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目的:通过观察围手术期及术后3个月肾移植患者肾形态结构和相关血流的彩色多普勒超声指标变化,分析彩色多普勒超声对肾移植术后并发症的早期评估作用。方法:选择2005-04/2006-04在南方医院超声诊断科就诊的同种异体肾移植患者152例,患者均知情同意。应用彩色多普勒超声对肾移植患者进行术前评价和术后监测,重点观察肾移植术后3d、术后7d、术后1个月及术后3个月内移植肾形态结构及血流动力学各项参数,及时发现术后并发症。先用二维超声观察移植肾的形态,测量长径、宽径、厚径,并测量肾皮质厚度和锥体大小。随后应用彩色多普勒血流显像观察移植肾髂动脉、吻合口处肾动脉、肾门处肾动脉、段动脉的血流充盈情况,接着用高频探头检测大叶间动脉和小叶间动脉的血管树结构。最后用脉冲式多普勒采集频谱,测量收缩期峰值血流速度、舒张末期血流速度、阻力指数和搏动指数等。结果:152例肾移植患者全部进入结果分析,无脱落。术后彩色多普勒超声及时发现手术并发症64例,占肾移植患者的42.11%,部分受检者同时合并两项或多项并发症。①急性排斥反应23例,发病率15.14%,移植肾各级动脉阻力指数均大于0.75,其中大于0.85的患者共12例。②吻合口处肾动脉狭窄14例,发病率9.22%,收缩期峰值流速明显增高,均收缩期峰值流速>180cm/s,其中收缩期峰值流速>300cm/s的患者5例,占35.71%,14例病例中合并急性排斥者6例,占42.86%。③肾盂积水25例,发病率16.45%,移植肾大小为(208.52±42.43)cm3;肾周积液20例,发病率13.16%。结论:应用彩色多普勒超声动态观察肾移植术前、术后肾内血流灌注情况,以各项血流指标进行临床评估,有助于及早发现术后并发症,对于提高肾移植术的成功率和患者的生存率具有重要意义。
OBJECTIVE: To evaluate the early assessment of postoperative complications of renal allograft by color Doppler sonography by observing the changes of renal Doppler echocardiography and the changes of renal blood flow and renal blood flow during perioperative period and postoperative 3 months. Methods: 152 patients with renal allograft admitted to Nanhua Hospital from April 2005 to April 2006 were enrolled. All patients were informed consent. Application of color Doppler ultrasound in renal transplant patients before surgery and postoperative monitoring, focusing on the observation of renal transplantation 3d, 7d after operation, 1 month after operation and 3 months after transplantation, the morphology of renal graft and blood flow Kinetic parameters, timely detection of postoperative complications. The morphology of the transplanted kidneys was observed with two-dimensional ultrasonography. The long diameter, wide diameter and thickness were measured. The renal cortical thickness and cone size were measured. Subsequently, color Doppler flow imaging was used to observe the filling of the renal arteries and renal arteries at the anastomotic renal graft and renal arteries in the anastomosis, followed by the detection of the interlobular and interlobular arteries with a high-frequency probe The vascular tree structure. Finally, pulsed Doppler spectrum was collected to measure the peak systolic blood flow velocity, end diastolic blood flow velocity, resistance index and pulsatility index. Results: 152 cases of renal transplant patients all entered the result analysis, no shedding. Postoperative color Doppler ultrasound in 64 cases of surgical complications found in time, accounting for 42.11% of patients with renal transplantation, some subjects also combined two or more complications. ①Acute rejection in 23 cases, the incidence rate of 15.14%, arterial resistance index at all levels of graft were greater than 0.75, of which more than 0.85 in patients with a total of 12 cases. The anastomosis of renal artery stenosis in 14 cases, the incidence rate of 9.22%, peak systolic velocity was significantly higher systolic peak flow rate> 180cm / s, of which the peak systolic flow velocity> 300cm / s in 5 patients, accounting for 35.71% In 14 cases, 6 cases were acute rejection, accounting for 42.86%. ③ hydronephrosis in 25 cases, the incidence rate of 16.45%, the size of the grafted kidney was (208.52 ± 42.43) cm3; peritoneal effusion in 20 cases, the incidence rate of 13.16%. Conclusion: The renal blood flow perfusion before and after renal transplantation can be observed dynamically by color Doppler ultrasound, and the clinical evaluation of various blood flow indexes can help to find out the postoperative complications as soon as possible. Success rate and patient’s survival rate is of great significance.