彩色和脉冲多普勒超声检测移植肾术后无尿的价值  

Value of color Doppler flow imaging and pulsed Doppler ultrasonography in the diagnosis of anuria in patients after renal transplantation

作　　者：魏育英[1] 沈继斌[1] 沈水春[1] 孙晶[2] 田军[2] 

机构地区：[1]中国人民解放军455医院特诊科,200052 [2]中国人民解放军455医院肾脏病科,200052

出　　处：《上海医学影像》2004年第3期192-193,208,共3页Shanghai Medical Imaging

摘　　要：目的 CDFI和PD流速曲线舒张期流速曲线演变在评价肾移植术后无尿的价值。 方法 回顾21例术后无尿移植肾的CDFI和PD流速曲线变化,病理结果和出现排尿时间进行对照分析,参照移植肾急性血管排异反应,分为重度(7例)、中度(3例)、轻度(11例)。 结果 重度组7／21(33％),CDFI显示肾血管树消失,呈星辰闪烁状,PD流速曲线为单向收缩期血流值。术后7天内取出,病理分析主要为肾小动脉纤维样坏死,管腔内血栓形成,肾间质广泛出血伴坏死。中度组3／21(14％),CDFI显示血供丰富,血流信号呈树叉或线条状,PD流速曲线从单向收缩期血流值逐渐出现舒张期血流,最迟一例28天出现排尿,活检病理分析主要为肾小动脉小灶状纤维样坏死,少许细小血管内血栓形成,肾间质水肿伴少许出血点。轻度组11／21例(54％),CDFI肾血管树显示良好,PD流速曲线从单向收缩期血流值在1.0-4.0天内出现舒张期血流,在7天内全部出现排尿,活检病理主要为血管内皮细胞部分变性,单个核细胞浸润、肾间质轻度水肿。 结论 肾移植术后无尿病例CDFI肾动脉血管树显示良好,PD频谱从单一收缩峰值出现舒张期曲线,提示移植肾排异反应缓解,并将出现排尿。反之,则无保留移植肾的意义。Purpose To discuss the value of CDFI and PD spectrum evolvement in diastole in the assessment of anuria after renal transplantation. Methods A retrospective study was performed in 21 anuria patients after renal transplantation. CDFI and PD spectrum, the result of pathology and the time period from anuria to emiction were analysed. Three groups were divided based on acute vascular rejections after renal transplantation: severe(7), medium(3) and mild(11). Rseults The renal vascular tree disappeared and presented spot on CDFI in the severe group(7/21,33%). The spectrum curve was monomial systolic flow. The kidney had to be taken out with a pathology of renal artery cel-lulosic necrosis, thrombosis in the cavity and extensive bleeding and necrosis in the medulla. In the medium group(3/21,14%) blood supply was affluent and the renal vascular tree was crotched or lined. The spectrum curve changed from monomial systolic flow to the appearance of diastolie flow gradually. One patient emictioned at 28 days after the operation. The pathology of biopsy was renal arteriolar part cellulosie necrosis, thrombosis in the small vessel cavity and a little bleeding and oedema in kidney medulla. The renal vascular tree was shown clear in mild group (11/21,54%). The spectrum curve changed from monomial systolic flow to the appearance of diastolic flow in 4 days. AH patient emictioned in 7 days after the operation. The pathology was vascular endothelial cell denaturalization, monocyte invaded and mild oedema in kidney medulla by the biopsy. Conclusion Acute rejection of trans planted kidney will be relieved when the renal arterial flow is shown fine on CDFI and the appearranc.e of diastolic flow in spectrum curve gradually in the anuria patients. On the contrary, it is needless to keep the implanted kidney.

关 键 词：彩色多普勒超声 脉冲多普勒超声 超声检测 移植肾 术后无尿 急性血管排异反应 

分 类 号：R699.2[医药卫生—泌尿科学] R445.1[医药卫生—外科学]