彩色多普勒超声对端-端与端-侧吻合移植肾动脉重度狭窄的对比研究  

Evaluation of severe stenosis of end-to-end and end-to-side anastomosis of transplant renal artery with color Doppler sonography

作　　者：李建初[1] 高敬 张丽娜[2] 戴晴[1] 孟华[1] 蔡胜[1] 吕珂[1] 孝梦甦[1] 张一休[1] Robert J Min Amelia Ng David Trost Michael Goldstein Sandip Kupur John Wang David Serur 姜玉新[1] 

机构地区：[1]北京协和医院超声诊断科,100730 [2]山西医科大学第一附属医院超声科 [3]Department of Radiology [4]Department of Surgery [5]Department of Nephrology

出　　处：《中华超声影像学杂志》2008年第7期594-597,共4页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金资助项目（60671026）

摘　　要：目的探讨两种吻合方式（端-端吻合与端-侧吻合）移植肾动脉重度狭窄（内径减少≥80％）的彩色多普勒超声诊断指标的差异。方法回顾性分析彩色多普勒超声检查发现后并经数字减影血管造影（DSA）证实的38例移植肾动脉重度狭窄患者（端-端吻合和端-侧吻合各19例）。超声测量髂动脉、移植肾动脉主干和吻合口峰值流速（PSV），肾内叶间动脉或段动脉PSV和加速时间（AT），计算狭窄处与狭窄近端PSV比值（简称PSV前比）。结果血管造影显示所有患者的动脉内径减少≥80％；狭窄部位位于髂动脉4例，吻合口20例和移植肾动脉14例。狭窄处PSV、髂动脉PSV及PSV前比在两种吻合方式之间差异均有统计学意义（P〈0．01，P〈0．001，P〈0．001），但AT在两种吻合方式之间差异无统计学意义（P〉0．05）。结论两种吻合方式移植肾动脉重度狭窄患者的肾动脉血流动力学差异很可能是导致它们之间狭窄处PSV和PSV前比差异的主要原因。为了提高移植肾动脉重度狭窄的诊断准确性，应依据吻合方式来建立PSV前比的诊断阈值，而同-AT诊断阈值很可能适合两种吻合方式患者。Objective To investigate differences in Doppler parameters between severe transplant renal artery stenosis （TRAS,arterial lumen reduction ≥80%） with end to end anastomosis and that with end-to-side anastomosis. Methods Color Doppler sonography（CDS） and digital subtraction angiography（DSA） images were reviewed retrospectively in 38 patients with severe TRAS （19 cases with end-to-end anastomosis and 19 cases with end-to-side anastomosis）. All 38 cases with severe TRAS were initially diagnosed with CDS and confirmed by DSA afterwards. Doppler parameters,including the peak systolic velocity（PSV） in the renal, lilac, anastomosis site and segmental or interlobar artery,pre-PSV ratio （the ratio of the PSV at the stenotic site to that in the lilac artery）, acceleration time（AT） in the intrarenal arteries, were measured or calculated. Results DSA demonstrated all patients with severe arterial stenosis （diameter reduction ≥ 80%）. With regard to the location of stenosis, 4 stenotic lesions were found in the lilac artery,20 were at the site of the anastomosis,and the other 14 involved the transplanted renal artery. There were statistically significant differences in PSV in the stenotic artery （ P 〈0.01 ）, PSV in the lilac artery （ P〈0. 001 ） and pre-PSV ratio （ P 〈0. 001 ） between TRAS with end to end anastomosis and that with end-to-side anastomosis. However, there was no statistically significant difference in AT in the intrarenal artery between the two types of anastomosis （ P 〉 0.05）. Conclusions Significantly hemodynamicdifferences between severe TRAS with end-to-end anastomosis and that with end-to-side anastomosis may be the reason for the significantly statistical differences in PSV in the stenotic artery and pre-PSV ratio, In order to raise the diagnostic accuracy for severe TRAS, pre-PSV ratio should be established according to the types of arterial anastomoses. However,the same diagnostic cutoff of AT is probably suitable for both types of anastomosis.

关 键 词：超声检查 多普勒 肾移植 肾动脉梗阻 血液动力学现象 

分 类 号：R686[医药卫生—骨科学]