16例次供肝手术的总结

供肝质量好坏 ,是肝移植成败的重要环节。作者参加供肝手术 1 6例次 ,其中 1 4例次在芝加哥 Rush医疗中心进行 ,两例在国内 ,均获得了满意的供肝 ,现将有关供肝灌注方法选择及切取方面的体会总结如下 ,并结合 2 3例次猪肝移植时供肝获取的经验 ,探讨适合我国现况的供肝手术法。1　资料与方法1 .1　一般情况　本组均为脑死亡供体共 1 6例 ,其中男 9例 ,女 7例 ,年龄 1 4～ 6 0岁 ,同一供体联合切取肝、肾、胰、小肠、心、肺 1例 ;肝、肾、心、肺 3例 ;肝、肾、心、胰 1例 ;肝、肾、胰 2例 ;肝、肾、心 1例 ;肝、肾 6例 ;单纯获取肝 2例。1 .…     

尸体胰、十二指肠和肾脏联合快速获取与保存

尸体胰、十二指肠和肾脏联合快速获取与保存①２１０００２南京南京军区南京总医院李幼生黎介寿李宁罗开李为苏李元新关键词胰腺移植；器官保存中国图书资料分类号Ｒ６５７．５胰、十二指肠或胰、十二指肠及肾脏联合移植已成为糖尿病或糖尿病合并肾衰病人有效的治疗方法，...     

腹部器官移植术后的多层螺旋CT评价

目的:评价多层螺旋CT(MSCT)及其后处理技术对腹部器官(肝、肾、胰腺)移植术后并发症的诊断价值。方法:7例患者(胰肾Ⅰ期联合移植3例,1例为肝肾联合移植,1例为肝移植,2例为肾移植),7 次CT检查在术后16 天到8年进行。采用GE lightspeed 16 CT 99OCO螺旋CT,行平扫及增强扫描,层厚10 mm,1.25 mm层厚重建,并传入GEAW 4.0工作站进行后处理。结果:7例移植肾(其中1例移植肾患者移植了两个肾脏),4 例正常,1 例显示轻度急性排斥反应,1例显示右髂内动脉与肾动脉端端吻合口近端明显狭窄,1例显示肾段动脉闭塞;2例移植肝脏及3例移植胰腺均未见明显异常。结论:MSCT以及后处理技术能清晰显示和诊断腹部器官移植术后大部分并发症。     

胰肾Ⅰ期联合移植术后并发症的观察

于 2 0 0 2年 3月 11日首次实施胰肾Ⅰ期联合移植 ,患者男性 ,年龄 5 3岁 ,糖尿病史 6年 ,尿毒症史 3年 ,术前行血液透析疗法 2年 ,采用全胰十二指肠肾脏的移植方式 ,胰液的外分泌予以保留并经膀胱作为胰液的引流途径。术后短期内胰肾发挥了正常的生理功能 ,停用口服降糖药及胰岛素 ,现就术后并发症的观察进行总结。1　排斥反应的观察和护理1.1　肾排斥反应观察　主要监测血清肌酐值的变化和每小时尿量 ,监测每小时尿量的变化是观察移植肾是否存活的关键 ,每小时尿量必须多于 10 0ｍｌ～ 2 0 0ｍｌ,同时监测患者的生命体证及早期自觉症状 ,…     

腹部囊性病变的CT介入治疗

腹部囊性病变涉及腹腔、盆腔等多个器官(如肝、胰和肾等),是临床常见疾病。随着放射介入技术的发展,采用经皮穿刺抽吸和药物注射为腹部囊性病变患者提供一种新的疗法。我院对30例腹部囊性病变患者行CT引导下抽吸和药物治疗,均取得了满意的临床效果,现总结如下。1材料与方法1.1一般资料30例中,男20例,女10例,年龄36～72岁,平均38岁。其中单发肾囊肿20例,多房性肾囊肿5例,胰尾部囊肿2例,肝囊肿3例。囊肿抽吸及硬化治疗28例,2例胰腺囊肿置管外引流,5例行增强扫描。对多囊及多房性病变做到多中心定位。1.2方法1.2.1设备、器械及药品采用Picker…     

肝病死亡病例多种组织的HBV-DNA和HBsAg检测(5例报道)

对血清学HBV感染标记阳性的5名肝病死亡病例,在进行尸检病理检查的同时,采集了肝脏以及肝外多种组织进行了HBV-DNA和HBsAg的检测。HBV-DNA检测采用斑点杂交技术(Dot blot hybridization),~(32)P HBV-DNA探针(Probe)由北京医科大学附属人民医院肝病研究室提供。组织HBsag的检测采用间接免疫荧光法。 5例肝脏组织的HBV-DNA检测均为阳性,3例并肝癌的癌组织亦为阳性。肝、脾、肾、腹腔淋巴结等组织的HBV-DNA阳性率均极高,胰、肺、皮肤次之。1例作了脊髓和视神经的HBV-DNA检测,亦为阳性,5例心脏组织均为阴性。5例中的4例作了血清HBV-DNA检测,仅1例阳性。5例中的3例以免疫荧光法检测HBsAg,肝、肾及肝癌组织均为阳性,而心、肺组织均为阴性。显微镜病理检查,肝、胰、肺组织均有明确的病理改变。 作者们提出HBV感染虽以肝脏为主,但却是一种多脏器感染。肝炎的肝外表现恐非单纯的免疫复合物所致。部分被诊断为内科肾脏疾患的病例,有可能实为肾脏的HBV感染,应予重视。     

海拔2260m地区异体肾移植(附9例报告)

在海拔 2 2 60ｍ地区 ,共完成异体肾移植9例 ,1 982年— 1 983年 5月完成 4例 ;2 0 0 0年7月— 2 0 0 1年 5月完成ＨＬＡ配型下尸体肾移植 4例 ,亲属供肾、活体肾移植 1例 ,报告如下。资料与方法1　一般资料　本组 9例 ,男 4例 ,女 5例 ,年龄 2 0岁～ 42岁 ,平均 3 0 .5岁。肾脏原发病 :慢性肾小球肾炎 8例 ,红斑狼疮性肾病 1例。移植前均行血液透析 ,透析次数 ( 1 2～ 62 )次。8例尸体肾移植供 -受体血型相符 1 0 0 % ,亲属供肾活体肾移植供 -受体Ｏ、Ａ血型相配。2 0 0 0年 7月— 2 0 0 1年 5月所行肾移植患者淋巴细胞毒试验 2 %～ 1 2 %…     

胰岛素体循环回流和胰液肠引流式胰肾联合移植手术技巧及围术期处理

目的 总结胰岛素体循环回流和胰液肠引流式胰肾联合移植的手术技巧与围术期处理经验,以降低手术风险和并发症发生率,提高移植器官的长期存活率.方法 回顾性总结分析2003-2010年解放军309医院全军器官移植中心收治的5例1型糖尿病并发糖尿病肾病引发尿毒症行胰岛素体循环回流和胰液肠引流式胰肾联合移植患者的临床资料、手术技...     

血行播散型结核累及腹部器官的CT强化特征及其优势解剖分布

目的 明确血行播散型结核累及腹部器官的CT强化特征及其优势解剖分布。资料与方法 经临床病理证实的累及腹部器官的血行播散型结核11例，行腹部CT增强扫描，在CT图像上，观察受累淋巴结的大小、形态、强化特征和分布，以及受累肝、脾和肾脏内病灶的大小、形态、密度以及结核灶周边强化特点。结果 血行播散型结核优势地累及小网膜、肠系膜、胰周以及腹主动脉周围上、下部淋巴结。10例(90．9％)受累淋巴结增大呈环状强化，周边强化的淋巴结易形成多房样征象。10例(90．9％)肝脏呈均匀密度增大，11例(100％)脾脏呈不均匀密度增大，内有散在低密度灶，直径0．3～2．5cm，病灶周边有强化。6例(54．5％)肾脏受累(双侧2例，单侧4例)，肾实质内有低密度灶，灶周强化。结论 血行播散型结核累及腹腔、腹膜后淋巴结存在优势解剖分布，同时肝脏多呈均匀密度增大，脾呈不均匀密度增大，这些特征与感染途径及结核灶的病理特点有关。     

胰肾联合移植术后多层螺旋CT表现

目的 应用多层螺旋CT（MSCT）及其后处理技术评价胰肾联合移植术后移植物的影像学表现及并发症的征象。资料与方法 14例行胰肾联合移植术的患者作16次MSCT检查。采用GE Lightspeed 16螺旋CT扫描仪,行平扫及增强扫描,然后将所有图像传入GE AW4．0工作站进行多平面重建（MPR）、最大密度投影（MIP）及容积再现技术（VR）进行后处理。结果 14例移植胰腺中,MSCT显示12例胰腺实质正常,CTA显示胰腺血管无狭窄及栓塞等异常;1例移植胰腺右侧髂外动脉近起始部至股动脉处血栓形成,胰腺体积小、密度低,未见明显强化,术后病检示胰腺内脾动脉血栓形成,胰腺缺血坏死及胰腺急性排斥反应;1例胰腺包膜下积液。14例移植肾显示11例肾实质正常,1例动脉期肾皮髓质分界欠清晰,提示为轻度急性排斥反应,后亦经肾穿刺所证实;1例MIP显示2处移植肾动脉狭窄;另1例显示移植肾静脉瘤形成。7例患者中MSCT均可见胰周、肾周少量积液。结论 MSCT以及后处理技术能对胰肾联合移植术后移植胰腺和肾脏形态及基本功能状态作出评估。     

多层螺旋CT后处理图像对亲属活体供肾术前的综合评价

目的 评价多层螺旋CT(MDCT)后处理图像对亲属活体供肾摘取手术前评估供肾状况的价值.资料与方法 施行开放供肾摘取手术20例,术前全部供者均使用MDCT后处理图像显示供肾血管、上尿路、肾实质及供肾与周围脏器的空间关系,重建层厚和层距采用1.25 mm和1 mm,将术中所见和术后摘取的供肾与术前的CT后处理图像进行对照,评价CT后处理图像的敏感性和准确性.结果 20例供肾者CT数据经后处理后均获得了满意的CT血管成像(CTA)、CT尿路成像(CTU)、多平面重建(MPR)及容积再现(VR)图像,清晰地显示了肾血管的分支、数目、长短、粗细,上尿路的形态,肾实质情况,肾脏与毗邻周围器官的空间立体关系,CT后处理图像显示的肾脏血管情况、上尿路形态、肾实质及供肾与周围脏器的空间关系与手术所见相同.结论 使用MDCT后处理图像可代替DSA、排泄性尿路造影(IVP)及超声检查,准确而全面地评价移植前亲属供体的肾脏血管、上尿路、肾实质及肾脏与周围脏器的空间立体关系.     

Kidney allografts and remaining contralateral donor kidneys before and after transplantation: assessment by quantitative (99m)Tc-DMSA SPECT.

We used (99m)Tc-dimercaptosuccinic acid (DMSA) quantitative SPECT (QDMSA) to assess the function of kidneys before harvesting and after transplantation as well as the function of remaining donor kidneys. METHODS: Nineteen kidney donors underwent a baseline QDMSA study before nephrectomy. The allografts of these kidneys were studied in recipients at 1 wk, 1-2 mo, and 6-15 mo after transplantation. The kidneys remaining in 16 donors were studied at 1-2 mo and 6-15 mo after harvesting. The parameters obtained in each SPECT study included functional volume, concentration of (99m)Tc-DMSA per cubic centimeter of renal tissue, and total kidney uptake. Clinical evaluation and determination of serum creatinine levels took place at the same time as SPECT. RESULTS: On the basis of the clinical evaluation, 14 grafts had normal function and 5 were impaired. The mean +/- SD of kidney uptake values expressed as percentage of baseline values were 131% +/- 30% in normal grafts versus 57% +/- 5% in impaired grafts at 1 wk (P < 0.01), 173% +/- 57% versus 65% +/- 10% at 1-2 mo (P < 0.001), and 190% +/- 50% versus 69% +/- 14% at 6-15 mo after transplantation (P < 0.01). Uptake values in the donors' remaining kidneys were 159% +/- 27% of baseline values at 1-2 mo and 164% +/- 30% at 6-15 mo after nephrectomy. Allografts and remaining kidneys showed a similar increase in total kidney uptake as a result of an increase in both functional volume and concentration. CONCLUSION: QDMSA may be a noninvasive assessment tool in kidney transplantation from living donors.     

In vivo NMR imaging and spectroscopic investigation of renal pathology in lean and obese rat kidneys

Diabetic nephropathy is a major cause of end-stage renal failure. While our understanding of the pathogenesis of nephropathy is incomplete, progressive glomerular injury appears to play a significant role in the decline of renal function. Proton NMR spectroscopy and imaging techniques were used to address changes in renal pathology associated with glomerular mesangial expansion in vivo in kidneys from spontaneously obese and lean (control) littermate Zucker rats. Fully functioning rat kidneys were surgically exposed and externalized for direct NMR signal detection via a coil placed around the organ. High-resolution (78 μm in plane) proton images were obtained at 4.7 T magnetic field strength revealing fine structure within the well-defined cortical and medullary regions. The obese rat kidney images were distinct in appearance from the lean kidney images and exhibited marked cortical expansion as well as increased overall kidney size. Enlargement of mean glomerular diameter was verified histologically in the obese kidneys as compared with the lean kidneys. Proton T₁ and T₂ relaxation times were determined from the entire kidney using standard spectroscopic techniques, and from specific regions within the kidney from multiple T₁ and T₂-weighted images. Additionally, image contrast enhancement resulting from saturation transfer between protons in restricted-mobility environments and mobile water protons within the kidney was investigated in the lean and obese rat kidneys using magnetization-transfer imaging techniques. At the early stage of renal injury examined in this study, diseased and healthy kidneys could not be differentiated on the basis of relaxation times alone. The magnitude of saturation transfer obtained in cortical tissue in the lean and obese kidneys was also not statistically significantly different. However, the magnitude of saturation transfer achieved in the medullary tissue of obese kidneys was statistically significantly less than that achieved in lean kidneys.     

64层CT肾血管成像在肾移植供体评价中的临床应用价值

目的:评价64层螺旋CT肾血管成像技术在肾移植供体评价中的临床应用价值。方法:对40例亲属供肾者行64层螺旋CT肾血管成像,应用容积再现(VR)、最大密度投影(MIP)、多平面重组(MPR)等技术进行肾血管重建,评价供肾血管情况,将影像学表现与术中所见进行对照。结果:40例供肾者1次屏气完成扫描,均获得满意的轴面图像,应用VR、MIP、MPR等后处理技术重建肾血管,可清晰显示肾动脉主干及其2～4级分支。9例单侧肾由副肾动脉供血,其中8例单侧肾见单支副肾动脉,1例双侧肾各见1支副肾动脉;9例存在肾动脉分支过早,其中1例双肾动脉均为肾动脉分支过早,共10支血管距离肾动脉开口在1.5cm以内;2例显示肾静脉解剖变异。CT血管成像对供肾动静脉主干、副肾动脉、肾动脉分支过早、肾静脉主干变异的显示与术中所见一致。结论:64层螺旋CT肾血管成像是肾移植术前评价活体供肾血管的一种无创、安全、经济、有效的检查方法。     

MIRD Pamphlet No 19: absorbed fractions and radionuclide S values for six age-dependent multiregion models of the kidney.

As one of the major organs of the excretory pathway, the kidneys represent a frequent source of radiopharmaceutical uptake in both diagnostic and therapeutic nuclear medicine. The unique organization of the functional tissues of the organ ensures transient changes in suborgan localization of renal activity. Current single-region dosimetric models of the kidneys, however, force the assumption of a uniform distribution of radioactivity across the entire organ. The average absorbed dose to the kidneys predicted by such models can misrepresent local regional doses to specific substructures. METHODS: To facilitate suborgan dosimetry for the kidneys, 6 new age-dependent multiregion kidney models are presented. The outer dimensions of the models conform to those used currently in single-region kidney models, whereas interior structures are defined for the renal cortex, the medullary pyramids with papillae (2 vertical and 3 horizontal), and the renal pelvis. Absorbed fractions of energy were calculated for both photon and electron sources (10 keV to 4 MeV) located in each source region within the 6 age-dependent models. The absorbed fractions were then used to assemble S values for radionuclides of potential interest in suborgan kidney dosimetry. RESULTS: For the adult, the absorbed dose to the renal cortex for (90)Y-labeled compounds retained within that subregion is approximately 1.3 times that predicted by the single-region kidney model, whereas the medullary dose is only 26% of that same single-region value. For compounds that are rapidly filtered in the kidneys, the renal cortex dose is approximately one-half of that predicted under the single-region model, whereas the tissues of the medullary pyramids receive an absorbed dose 1.5-1.8 times larger. CONCLUSION: The multiregion model described here permits estimates of regional kidney dose not previously supported by current single-region models. Full utilization of the new model, however, requires serial imaging of the kidneys with regions of interest assigned to the renal cortex and medulla.     

先天性肛门闭锁异位肾SPECT/CT显像一例

笔者报道了先天性肛门闭锁异位肾SPECT/CT显像一例。异位肾患者由于早期缺乏特异性的临床症状,大多数患者都是体检时偶然发现。目前诊断异位肾主要靠超声及CT,但是对异位肾分肾肾功能的评价,肾动态显像具有明显的优势。笔者通过文献复习加深了对Gate's法的认识,结合该病例得出指导性结论:1、对已发现有一器官畸形的新生儿,应该留意是否合并其他器官的畸形,做到早发现早干预;2、SPECT/CT可对异位肾的形态及功能进行一站式诊断,优势明显;3、对于特殊肾脏的肾小球滤过率的测定,Gate's法需要适当的矫正。     

Segmental acute tubular necrosis in kidneys with multiple renal arteries transplanted from living related donors.

Ten patients received kidneys from living, related donors, the transplants having multiple renal arteries; a retrospective analysis of the postoperative Hippuran renograms is presented. All seven kidneys that had the large artery reopened before anastomosis of the smaller, developed scintigram findings suggestive of acute tubular necrosis (ATN) in the region with the more prolonged ischemia. Three similar kidneys with simultaneous recanalization of both renal arteries had normal Hippuran scintiphotos. Electron photomicrographs from upper- and lower-pole biopsies--in one case undergoing sequential revascularization--confirm the development of ischemic changes consistent with ATN in the half of the kidney developing scan findings of ATN.     

高血压患儿病因及其靶器官损害相关因素分析

 目的 分析儿科原发性与继发性高血压患儿的临床资料,为鉴别原发性高血压与继发性高血压,并探讨原发性高血压患儿靶器官早期损害诊断与治疗。方法 回顾性分析本医院自1992-01至2016-05确诊为高血压的住院患儿,按照病因分为原发性高血压和继发性高血压,分别对其一般情况、继发性高血压病因、原发性高血压靶器官损害的情况进行统计学分析。结果 (1)原发性高血压患儿平均11.76岁,体重指数BMI均值26.90 kg/m²,高于继发性高血压患儿平均年龄(7.38岁)及BMI均值(19.94 kg/m²),差别具有统计学意义(P=0.000)。(2)继发性高血压患儿在婴幼儿期、学龄前期、学龄期及青春期高血压患儿的构成比分别为94.7%、48.3%、17.0%、8.6%,发病年龄越早,继发性高血压的可能性越大,随着年龄增长,原发性高血压检出率逐渐增多。(3)分析继发性高血压病因:肾脏病变仍为继发性高血压首要病因,占59.42%,继发性高血压平均血压水平高于原发性高血压。(4)82.0%入院诊断原发性高血压的患儿已出现靶器官损害,血、尿β₂微球蛋白升高可作为监测原发性高血压早期肾脏损害的敏感指标;平均舒张压水平升高和空腹胰岛素升高患儿更易出现原发性高血压靶器官损害。结论 继发性高血压发病年龄早,血压水平高,其首要病因为肾实质及肾血管疾病。儿童原发性高血压大部分在诊断时即已出现靶器官损害,血、尿β₂微球蛋白检测可作为肾脏早期受损的筛查指标。平均舒张压升高和空腹胰岛素升高患儿更易出现原发性高血压靶器官损害。     

髓质海绵肾的影像学诊断

目的　结合文献复习进一步探讨髓质海绵肾各种影像学检查方法的临床应用价值。方法　回顾分析了 11例髓质海绵肾腹部平片 ( 1例 )、静脉肾盂造影 (IVP) ( 2例 )、B超 ( 3例 )及CT( 9例 )表现。结果　X线平片 1例 1肾见肾乳头、髓质区成簇排列的圆形、椭圆形高密度影。IVP 2例 3肾显示收集管呈线状、刷子状、囊状扩张。B超 3例 5肾见肾髓质内有散在密丛状排列的强回声光点 ,后方伴有声影 ,2例 3肾集合管呈囊样扩张。CT 9例 16肾有沿肾髓质分布的海绵肾结石 ,3例 5肾增强CT扫描后见结石被造影剂覆盖 ,同时有增强的条纹状高密度影从乳头伸向髓质。结论　平片、IVP、B超、CT均可用于诊断髓质海绵肾 ,X线平片、IVP仍是首选检查方法 ,IVP对集合管的扩张显示较为特异、直观 ,B超特别是CT对海绵肾结石显示率高 ,对集合管的扩张也能做出一定评价     

Tc-99m MAG3 evaluation of recipients with dual adult cadaveric renal allografts. Simultaneous transplantation of both kidneys from marginal donors.

PURPOSE: The application of Tc-99m mercaptoacetyl triglycine (MAG3) renal scintigraphy in patients who had simultaneous unilateral retroperitoneal transplant of both kidneys from marginal adult cadaveric donors is assessed. METHODS: Eighteen patients who had this unusual form of kidney transplant were monitored and evaluated by Tc-99m MAG3 renal scintigraphy. More than 60 of the radioisotopic studies, including immediate postoperative and subsequent follow-up examinations, were performed among these patients. RESULTS: In all the studies, the two transplanted kidneys were not equally well visualized by this scintigraphic procedure because of the inherent difference in their depth from the body surface, a feature of this particular surgical design. Despite this limitation, the efficacy of the scintigraphic procedure for such dual renal allografts appears to be similar to that established for kidney transplants performed in the conventional manner. CONCLUSION: To use the scintigraphic procedure effectively, certain sensible and logical adjustments are needed for the comparative visual and semiquantitative assessments of the two kidneys in this special form of transplantation.