Skjoldbye B, Nielsen A H, Court-Payen M, Nørgaard N, Rasmussen F, Løkkegaard H, Lorentzen T, Holm H H
Department of Ultrasound, Herlev Hospital, Copenhagen University, Denmark.
Scand J Urol Nephrol. 1998 Sep;32(5):345-9. doi: 10.1080/003655998750015313.
Irreversible damage of renal transplants may be prevented if insufficient graft perfusion can be detected perioperatively. Colour and spectral Doppler ultrasonography were performed in 30 consecutive renal transplants. The perfusion of the graft and the Resistive Index (RI) were evaluated perioperatively (perioperatively and less than 15 min postoperatively) and 24 h after the operation in all patients. In four cases (13.3%) RI > 0.9 was detected and immediate surgical correction of the cause led to a normalization (RI < 0.8) in all four cases. A RI < 0.9 required no intervention in 26 cases (86.7%). All renal grafts in this series were functioning 1 month postoperatively. In a comparative group, 30 consecutive transplants carried out at our institution without perioperative Doppler ultrasonography evaluation, a loss of four renal grafts perioperatively was recorded retrospectively. We conclude that perioperative ultrasonography Doppler evaluation may provide an easy applicable and reliable method for early detection of insufficient renal graft perfusion, allowing surgical correction before irreversible damage of the graft occurs. RI > 0.9 is pathological. A continuation of the study is required to clarify the long-term value of perioperative Doppler ultrasonography graft monitoring.
如果能在围手术期检测到肾移植灌注不足，就可以预防肾移植的不可逆损伤。对30例连续肾移植患者进行了彩色和频谱多普勒超声检查。在所有患者中，于围手术期（围手术期及术后不到15分钟）和术后24小时评估移植肾的灌注及阻力指数（RI）。4例（13.3%）检测到RI>0.9，立即对病因进行手术纠正后，所有4例的RI均恢复正常（RI<0.8）。26例（86.7%）RI<0.9的患者无需干预。该系列中的所有肾移植在术后1个月均功能良好。在一个对照组中，对本机构连续进行的30例未进行围手术期多普勒超声评估的移植手术进行回顾性记录，发现围手术期有4例肾移植失败。我们得出结论，围手术期超声多普勒评估可为早期发现肾移植灌注不足提供一种易于应用且可靠的方法，从而在移植肾发生不可逆损伤之前进行手术纠正。RI>0.9为病理性。需要继续开展研究以阐明围手术期多普勒超声监测移植肾的长期价值。
