Lin Lan, Chen Zheng, Liu Luhao, Mai Xinghuan, Huang Jiefang, Liu Sijie
Ultrasound Diagnosis Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Ann Transl Med. 2022 Jul;10(14):770. doi: 10.21037/atm-22-3134.
Simultaneous pancreas-kidney transplantation is an important treatment approach for diabetic renal insufficiency, but pancreatic arteriovenous thrombosis is among the early serious surgical complications that can lead to graft loss and even be fatal. Ultrasound is considered to be a safe and non-invasive approach, but it is often affected by intestinal gas interference and operator proficiency, partial thromboses may be easily missed. Computed tomography angiography (CTA) and computed tomography venography (CTV) are highly accurate but radiative, requiring the use of contrast agents.
A total of 194 patients with end-stage diabetic nephropathy who underwent simultaneous pancreas-kidney transplantation from September 2016 to May 2021 were selected, among which 32 patients with highly suspected arteriovenous thrombosis were enrolled as the research subjects. All patients were examined by color Doppler ultrasonography, CTA and CTV. CTA and CTV are the gold standard for diagnostic imaging. The diagnostic value of color Doppler ultrasound, CTA and CTV in the diagnosis of pancreatic arteriovenous thrombosis was compared. and Kappa coefficient was used for consistency test.
Among the 32 patients with high clinical suspicion of transplanted pancreatic arteriovenous thrombosis after simultaneous pancreas-kidney transplantation, 9 patients were diagnosed by CTA/CTV and 10 patients were diagnosed by color Doppler ultrasonography, of which 2 cases were false positive and 1 case false negative. After transplantation, the normal diameter of the donor splenic vein was 3.96±0.16 mm. The difference in the diameter of the donor splenic vein between those with and without donor splenic vein thrombosis was statistically significant (P<0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of color Doppler ultrasound in the diagnosis of arteriovenous thrombosis were 88.9%, 91.3%, 90.6%, 80%, and 95.5%, respectively. There was no significant difference between color Doppler ultrasound diagnosis of arteriovenous thrombosis and CTA and CTV results (McNemar test P=1). The diagnosis of arteriovenous thrombosis by color Doppler ultrasonography was consistent with that of CTA and CTV (Kappa coefficient =0.776).
Color Doppler ultrasonography has the advantages of safety and radiation-free, and can be used as the first choice for diagnosis of pancreatic arteriovenous thrombosis after simultaneous pancreas-kidney transplantation.
胰肾联合移植是治疗糖尿病性肾功能不全的重要方法，但胰腺动静脉血栓形成是早期严重的手术并发症之一，可导致移植物丢失甚至死亡。超声被认为是一种安全无创的方法，但常受肠道气体干扰及操作者熟练程度影响，部分血栓可能易被漏诊。计算机断层血管造影（CTA）和计算机断层静脉造影（CTV）准确性高，但具有放射性，且需使用造影剂。
选取2016年9月至2021年5月行胰肾联合移植的终末期糖尿病肾病患者194例，其中32例高度怀疑有动静脉血栓形成的患者作为研究对象。所有患者均行彩色多普勒超声、CTA及CTV检查。CTA和CTV是诊断性影像学检查的金标准。比较彩色多普勒超声、CTA及CTV对胰腺动静脉血栓形成的诊断价值，采用Kappa系数进行一致性检验。
在32例胰肾联合移植术后临床高度怀疑移植胰腺动静脉血栓形成的患者中，CTA/CTV确诊9例，彩色多普勒超声确诊10例，其中假阳性2例，假阴性1例。移植后供体脾静脉正常直径为3.96±0.16mm。有供体脾静脉血栓形成者与无供体脾静脉血栓形成者供体脾静脉直径差异有统计学意义（P<0.05）。彩色多普勒超声诊断动静脉血栓形成的灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为88.9%、91.3%、90.6%、80%及95.5%。彩色多普勒超声诊断动静脉血栓形成与CTA及CTV结果比较差异无统计学意义（McNemar检验P=1）。彩色多普勒超声诊断动静脉血栓形成与CTA及CTV诊断结果具有一致性（Kappa系数=0.776）。
彩色多普勒超声具有安全、无辐射的优点，可作为胰肾联合移植术后胰腺动静脉血栓形成诊断的首选方法。
