移植肾动脉狭窄影像学诊断方法的比较研究

目的:对移植肾动脉狭窄的影像学诊断方法进行比较和评价.方法:对我院所行1 524例(1 604例次)同种异体肾移植手术中明确发现移植肾动脉狭窄的14例患者的临床资料进行回顾性分析.14例均行彩色多普勒超声(CDI)及数字减影血管造影(DSA)检查,其中4例还进行了移植肾动脉磁共振血管造影(MRA)检查.另选择20例正常移植肾患者作为正常对照组也行CDI检查.结果:14例中有移植肾动脉吻合口明显狭窄者4例,均行移植肾动脉经皮腔内血管成形术(PTA);有移植肾动脉吻合口远端近肾门处明显狭窄者4例,其中2例行移植肾动脉探查及狭窄区松解术(另2例药物控制血压,拒绝进一步治疗);术后血压均基本恢复正常.余6例均为移植肾动脉吻合口轻度狭窄,服用药物能控制血压.结论:(1)CDI是一种无创性检查方法,可反复观察,对观察移植肾血流及血流指数的变化有一定的意义.(2)MRA是目前最为新颖的诊断手段,对患者无创伤性,能初步显示血管狭窄的部位和程度,今后可作为常规检查方法用于指导治疗.(3)DSA虽属创伤性检查,但诊断确切,能明确显示血管狭窄的部位和程度,并能同时行腔内治疗.

Evaluation of transplant renal artenosis with CDI,DSA and MRA

Objective: To compare the diagnostic value of color duplex ultrasound image(CDI),enhanced magnetic resonance angiography(MRA) and digital subtraction angiography(DSA)in transplant renal artenosis. Methods: From Aug 1978 to Feb 1998,1 524/1 604 cases of renal transplantation were done in our hospital,of which 14 cases developed transplant renal artenosis.Fourteen cases underwent CDI and DSA;four underwent enhanced MRA.Results:Four cases showed patent anastomotic artenosis, four showed patent approach reniportal artenosis, six showed slight anastomotic artenosis.Four cases were treated by percutaneous transluminal angioplasty (PTA).The lysis were done in 2 cases. Another 6 cases were treated with medicine.Couclusion:(1)CDI may provide a feasible method in screening and diagnosing transplant renal artenosis.(2)Enhanced MRA is an accurate minimally invasive method for detecting renal artenosis and a promising approach to evaluate transplant renal arteries.(3)DSA is invasive and has the risk of nephroxicity,but it can show the situs and level of the transplant renal artenosis clearly, and it allows to treat transplant renal artenosis through PTA.