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

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。

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

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