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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 553 -557. doi: 10.3877/cma.j.issn.1674-0785.2022.06.016

临床研究

床旁超声在同期胰肾联合移植治疗I型糖尿病术后的检查思路与探讨
梁晓宁1, 吕朝阳1, 郭瑞君1,()   
  1. 1. 100020 北京,首都医科大学附属北京朝阳医院超声医学科
  • 收稿日期:2022-05-01 出版日期:2022-06-15
  • 通信作者: 郭瑞君

Application of bedside ultrasound in simultaneous pancreas-kidney transplantation for type I diabetes mellitus

Xiaoning Liang1, Chaoyang Lv1, Ruijun Guo1,()   

  1. 1. Department of Ultrasound Medicine, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing 100020, China
  • Received:2022-05-01 Published:2022-06-15
  • Corresponding author: Ruijun Guo
引用本文:

梁晓宁, 吕朝阳, 郭瑞君. 床旁超声在同期胰肾联合移植治疗I型糖尿病术后的检查思路与探讨[J]. 中华临床医师杂志(电子版), 2022, 16(06): 553-557.

Xiaoning Liang, Chaoyang Lv, Ruijun Guo. Application of bedside ultrasound in simultaneous pancreas-kidney transplantation for type I diabetes mellitus[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(06): 553-557.

目的

总结床旁超声在胰肾联合移植(SPK)术后的应用,并就超声扫查思路、超声参考参数及术后并发症等方面做相关探讨。

方法

回顾性分析2009年7月至2020年12月于北京朝阳医院行胰肾联合移植术后超声评估的I型糖尿病患者计6位,记为1~6,分析总结其血管重建术式、胰腺动静脉的血流动力学参数、并发症等情况。

结果

6位患者中4位患者术后出现胰肾免疫排斥反应,胰腺内动脉的血流阻力指数均升高,阻力指数(RI)为0.74~0.87,峰值流速(PSV)为87~90 cm/s;另2位患者胰腺动脉RI分别为0.69、0.72;且该4位患者移植胰腺与移植肾脏均同期出现并发症;6位患者的回流静脉吻合方式均为经体循环回流,其中1例患者为供体门静脉与受体的髂外静脉端侧吻合,另5例为供体的门静脉与受体的下腔静脉端侧吻合;该6位患者血管重建的方式均为“Y”型血管吻合,供肾的肾动脉与供体的髂内动脉吻合、供体的腹主动脉袖片(包含腹腔干与肠系膜上动脉)与供体的髂外动脉吻合、供体的髂总动脉与受体的髂外动脉的端侧吻合。

结论

床旁超声在对胰肾联合移植术后器官功能评估中有较大的临床应用价值,重建的血管是扫查要点,超声医师的诊断思路需要与外术的具体操作密切结合。

Objective

To investigate the application of bedside ultrasound in type I mellitus diabetes patients after simultaneous pancreas-kidney transplantation (SPK), and to discuss the strategies, reference parameters, and postoperative complications of ultrasound scanning.

Methods

From July 2009 to June 2020, the hemodynamic parameters, vascular reconstruction procedures, and complications of six patients with type I mellitus diabetes were retrospectively analyzed.

Results

Among the six patients, four developed pancreatic renal immune rejection, in which the resistance index (RI) of the internal pancreatic artery was 0.74~0.87, and peak systolic velocity (PSV) was 87~90 cm/s; the RI of the other two patients was 0.69 and 0.72, respectively. In the four patients with pancreatic renal immune rejection, complications occurred in both pancreas and kidney grafts. One patient underwent end to side anastomosis between the donor's portal vein and the recipient's external iliac vein, and the other five patients underwent end to side anastomosis between the donor's portal vein and the recipient's inferior vena cava. All the six patients underwent Y-shaped vascular anastomosis, and the renal artery of the donor kidney was the same as that of the donor kidney. The internal iliac artery was anastomosed, the abdominal aorta sleeve (including celiac trunk and superior mesenteric artery) of the donor was anastomosed with the external iliac artery of the donor, and the common iliac artery of the donor was anastomosed with the external iliac artery of the recipient end to side.

Conclusion

Bedside ultrasound has great clinical value in the evaluation of organ function after SPK. The reconstruction of blood vessels is the key point of scanning. The diagnostic strategies of ultrasound doctors need to be closely combined with the specific procedure of surgery.

表1 患者一般情况
图1 患者1术后移植胰腺与移植肾脏的超声表现。患者1,SPK术后一年复查,主诉:中腹部及右腹部不适1月余;一般情况:男,37y,肌酐200 ummol/L,空腹血糖10.1 mmol /L,血淀粉酶80 u/L,胰腺内动脉PSV为87 cm/s,RI为0.84,移植肾内动脉RI为0.79。图a为供体十二指肠胰腺段肠壁未见明显水肿;图b为移植胰腺未见明显肿胀,胰周未见明显积液;图c为胰腺内动脉频谱高尖,阻力指数0.84;图d、e为肾门处动脉血流通畅,但阻力指数增高,RI为0.84;图f为肾内段阻力增高,RI为0.79;图g为超微血流显像技术(SMI)示移植肾的中部及上部灌注减低;图h为回流静脉通畅,未见明显栓塞注:SPK为同期胰肾联合移植;PSV为峰值流速;RI为阻力指数;SMI为超微血流成像技术
1
Pociot F, Lernmark A. Genetic risk factors for type 1 diabetes [J]. Lancet, 2016, 387(10035): 2331-2339.
2
Weng J, Zhou Z, Guo L, et al. Incidence of type 1 diabetes in China, 2010-13: population based study [J]. BMJ, 2018, 360j5295.
3
Robertson RP, Davis C, Larsen J, et al. Pancreas and islet transplantation in type 1 diabetes [J]. Diabetes care, 2006, 29(4): 935.
4
Kandaswamy R, Stock PG, Gustafson SK, et al. OPTN/SRTR 2017 annual data report: pancreas [J]. Am J Transplant, 2019, 19 Suppl 2: 124-183.
5
Redfield RR, Scalea JR, Odorico JS. Simultaneous pancreas and kidney transplantation: current trends and future directions [J]. Curr Opin Organ Transplant, 2015, 20(1): 94-102.
6
Speight J, Reaney MD, Woodcock AJ, et al. Patient-reported outcomes following islet cell or pancreas transplantation (alone or after kidney) in Type 1 diabetes: a systematic review [J]. Diabet Med, 2010, 27(7): 812-822.
7
Farney AC, Rogers J, Stratta RJ. Pancreas graft thrombosis: causes, prevention, diagnosis, and intervention [J]. Curr Opin Organ Transplant, 2012, 17(1): 87-92.
8
Fridell JA, Shah A, Milgrom ML, et al. Ipsilateral placement of simultaneous pancreas and kidney allografts [J]. Transplantation, 2004, 78(7): 1074-1076.
9
Socci C, Orsenigo E, Zuber V, et al. Triple arterial reconstruction improves vascularization of whole pancreas for transplantation [J]. Transplantat Proc, 2006, 38(4): 1158-1159.
10
Tso PL, Cash MP, Pearson TC, et al. Simultaneous pancreas-kidney transplantation utilizing a common arterial conduit: early experience and potential applications [J]. Am J Transplant, 2003, 3(11): 1440-1443.
11
Dong M, Parsaik AK, Kremers W, et al. Acute pancreas allograft rejection is associated with increased risk of graft failure in pancreas transplantation [J]. Am J Transplant, 2013, 13(4): 1019-1025.
12
Liong SY, Dixon RE, Chalmers N, et al. Complications following pancreatic transplantations: imaging features [J]. Abdom Imaging, 2011, 36(2): 206-214.
13
Becker LE, Hallscheidt P, Schaefer SM, et al. A single-center experience on the value of pancreas graft biopsies and HLA antibody monitoring after simultaneous pancreas-kidney transplantation [J]. Transplant Pro, 2015, 47(8): 2504-2512.
14
Kersting S, Ludwig S, Ehehalt F, et al. Contrast-enhanced ultrasonography in pancreas transplantation [J]. Transplantation, 2013, 95(1): 209-214.
15
武红涛, 唐缨, 李菊香, 等. 超声造影诊断胰肾联合移植术后胰腺急性排异反应的价值, 中华超声影像学杂志, 2016, 25(5): 405-408.
16
Wu HT, Tang Y, Li JX, et al. The value of contrast-enhanced ultrasound in diagnosis of acute rejection after pancreas transplantation [J]. 2016, 25(5): 405-408.
17
Shapiro R, Jordan ML, Scantlebury VP, et al. Renal allograft rejection with normal renal function in simultaneous kidney/pancreas recipients: does dissynchronous rejection really exist? [J]. Transplantation, 2000, 69(3): 440-441.
18
Tolat PP, Foley WD, Johnson C, et al. Pancreas transplant imaging: how I do it [J]. Radiology, 2015, 275(1): 14-27.
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