Technical specifcation for diagnosis and treatment of ultrasonic imaging of organ transplantation in China (2019 edition)
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摘要: 为了进一步规范器官移植超声影像学的诊断和治疗,中华医学会器官移植学分会组织器官移植专家和超声影像学专家,总结器官移植超声影像学的国内外最新进展,结合临床实践,制定了包括设备准备及图像调整规范,肝脏移植、肾脏移植、胰腺移植、心脏移植的超声诊疗技术规范,超声介入治疗技术规范等一系列器官移植超声影像学诊疗技术规范(2019版)。
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图 1 门静脉分型示意图及超声图片
A图为门静脉分型示意图(日本京都大学分型标准),引自NAKAMURA T, TANAKA K, KIUCHI T, et al. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases[J]. Transplantation, 2002, 73(12):1896-1903;B、C图分别为A型门静脉,门静脉主干分支为门静脉左支和门静脉右支,右支又分为右前支和右后支;D图为B型门静脉,门静脉左支、右前支和右后支形成三叉形;E图为S4段静脉汇入肝左静脉;F图为S4段静脉汇入肝中静脉
Figure 1. Diagram and ultrasound images of portal vein typing
图 7 肾移植术后常见并发症的超声表现
A、B图为移植肾静脉栓塞,A图示移植肾形态饱满,肾内血流分布稀疏,B图频谱多普勒示移植肾动脉频谱收缩期上升陡直,下降快速,舒张期反向血流;C、D图为肾移植术后2年移植肾动脉吻合口狭窄,C图示肾内动脉呈小慢波,峰值流速低,加速时间延长,D图示肾动脉吻合口处高速血流,达150 cm/s;E、F图为移植肾动脉吻合口处假性动脉瘤形成,E图为二维超声示肾门处局限性无回声区,F图为CDFI示瘤体内“双向”血流信号,呈“涡流状”;G图为移植肾积水,集合系统分离;H图为移植肾内多发结石
Figure 7. Ultrasonic fndings of common complications after renal transplantation
图 10 胰腺移植术后常见并发症的超声表现
A、B图为移植胰腺重度排斥反应,A图示胰腺肿大,回声减低,B图示动脉频谱阻力指数升高;C、D图为移植胰腺动脉血栓,C图示动脉血流中断,胰腺内未见血流信号,D图示术中见移植胰腺梗死;E、F图为移植胰腺静脉血栓,E图示移植胰腺肿大,F图示胰腺静脉血栓,动脉出现舒张期反向血流;G、H图为移植胰腺炎,G图示胰腺轻度肿大,H图示动脉阻力指数升高;I图为移植胰腺周围积液(箭头示);J图为移植胰腺周围肿大的淋巴结
Figure 10. Ultrasonic fndings of common complications after pancreas transplantation
表 1 肝移植术后胆管内径正常范围
Table 1. Normal range of internal diameter of bile duct after liver transplantation
患者类型 胆管内径(mm) 主胆管 肝内二级胆管 肝内三级胆管 成人 6~8 < 3 < 2或不超过伴行门静脉内径的40% 儿童(≥1岁) 3~4 婴儿(< 1岁) 2~3 表 2 成人胰腺各部位测量值
Table 2. Measurements of each part of the pancreas in adults (cm)
部位 正常 可疑肿大 异常 胰头 < 2.0 2.1~2.5 > 2.6 胰体 < 1.5 1.6~2.0 > 2.1 胰尾 < 1.2 1.2~2.3 > 2.3 胰管 < 0.2 0.2~0.3 > 0.3 -
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