肝移植术前术后彩超监测的应用价值

 目的 探讨彩色多普勒超声(CDFI)对肝移植术前术后的应用价值.方法 对39例肝移植患者分别于术前术后多次进行彩色多普勒超声检查,并检查21例健康人肝的血流动力学改变.结果 术前彩色多普勒超声筛选适合手术患者36例,其中肝癌21例,肝硬化失代偿11例,肝硬化并肝癌4例.术后早期出现肝脏轻度增大,不同程度的胸腔积液、腹腔积液及胆囊窝积液.10例出现排斥反应,1例出现肝动脉并发症.结论 彩色多普勒超声对肝移植术前、术后的检查具有重要的临床意义,术前可选择适合手术的患者,术后可有效地观察移植肝形态学变化及血流动力学的变化,对提高肝移植手术的成功率有重要的应用价值.     

超声在肝移植术后胆道并发症诊治中的应用

目的:探讨超声在肝移植术后胆道并发症诊治中的价值.材料和方法: 6例实施肝移植术后临床拟诊胆道并发症的患者,以二维超声检查移植肝及肝周情况,以彩色多普勒超声评估肝动脉、下腔静脉血流,并与其他影像学检查相对比.结果: 胆系梗阻3例(2例合并肝内多发胆汁肿)、胆管内胆泥形成1例、胆漏2例(在超声引导下置管引流).肝动脉血栓2例.肝流出道狭窄合并血栓1例.结论: 超声在肝移植术道并发症的诊治中有着重要的应用价值.     

肝动脉阻力指数与肝移植术后胆道并发症的相关性分析

目的:通过彩色多普勒超声检测肝动脉阻力指数变化,评价其对肝移植术后胆道并发症的预测价值.方法:用彩色多普勒超声观察107例肝移植患者术后肝脏血流变化,将肝动脉阻力指数进行分类分析.结果:肝移植术后,发生胆道并发症者33例.出现低阻力指数者共44例,包括首次检查RI≤0.50、随访2次以上发现RI≤0.50及RI较首次检查降低>0.30者,其中30例术后发生胆道并发症.低阻力指数者胆道并发症发生率明显增高(P<0.01),阻力指数正常者胆道并发症发生率明显减低(P<0.01),高阻力指数者胆道并发症发生率与整体发生率差异无统计学意义(P>0.05).结论:肝动脉低阻力指数与胆道并发症有明显的相关性,超声可预测肝移植术后肝动脉供血不足导致的胆道并发症.     

MR胆道成像评价活体肝移植供体胆道结构的应用价值

目的 探讨MR胆道成像(MRC)评价活体肝移植供体肝内胆道结构的准确性以及在活体肝移植中的应用价值.方法 回顾性分析58例活体肝移植的供体,分析术前MRC资料,进行胆道分型,并与术中胆道造影(IOC)结果对照.结果 IOC诊断58例供体,发现胆道结构正常者34例(58.6%),胆道结构变异者24例(41.4%);MRC对58例供体胆道结构分型总准确率为91.4%(53/58),对胆道变异类型的诊断敏感度为83.3%(20/24),特异度为100%(34/34),阳性预测值为100%(20/20),阴性预测值为89.5%(34/38).结论 MRC能在术前准确评价活体肝移植供体的肝内胆管结构,有助于活体肝移植术前手术方案的制定.     

彩超在减体积肝移植术后流出道梗阻的诊断及介入治疗中的应用

 目的探讨彩色多普勒超声在儿童减体积肝移植术后流出道梗阻的诊断及介入治疗中的应用价值.方法 2例儿童减体积肝移植术后流出道梗阻并发症病例,分析流出道梗阻的彩色多普勒超声表现及介入治疗前后的血流动力学改变.结果例1为肝静脉狭窄,超声表现为管腔直径不足2.5 mm,狭窄长度达15 mm,血流速度115.0 cm/s,同时伴大量腹水、脾脏增大.球囊括张术后血流速度轻度下降,1周后又重新恢复高速血流.支架植入术后血流速度降至正常范围,腹水消失.例2为下腔静脉狭窄,超声表现为下腔静脉肝后段内径明显变细、其直径不足0.3 mm,血流速度增快达200 cm/s以上.结论彩色多普勒超声对减体积肝移植术后流出道梗阻的诊断及监测介入术后血流动力学改变方面具有重要作用.     

活体右半肝供体外科并发症预防、诊断和处理

 目的 分析活体肝移植供体右半肝切除术后外科并发症的临床特征及预防和处理措施. 方法 总结2年间,65例活体供体右半肝切取术后的临床资料,分析外科并发症发生情况及预防、处理措施.结果 术后累计发生外科并发症14例次(21.54%);其中切口脂肪液化、感染(4例,6.15%)及肝断面胆汁漏(4例,6.15%)是最常见的并发症;肺部感染、腹腔内出血、门静脉左支狭窄、腹腔引流管折断、胆管狭窄和小肝综合征各1例(1.54%).门静脉左支狭窄病例术中当即采用自体大隐静脉血管补片修补右支残端;胆管狭窄病例术中当即留置T形管;腹腔内出血、引流管折断和肝断面胆漏(1例)再次剖腹探查;另3例肝断面胆漏经皮穿刺引流痊愈.结论 右半肝供体有相当高的外科并发症,精细的手术技巧和及时处理是改善外科并发症预后的关键.     

活体肝移植中改良移植肝右叶的肝中静脉属支闭塞:对比增强超声检查的诊断

目的研究对比剂增强超声检查对于活体肝移植术后改良移植肝右叶肝中静脉属支闭塞的诊断能力。材料与方法研究获单位伦理委员会批准,无需知情同意书。研究包括2009年2月—5月间进行活体肝移植改良肝右叶移植术的65例病人(男48例,女17例,年龄33～69岁,平均52.8岁)。所有病人均于术后1天进行对比增强超声检查和多普勒超声检查,并于超声检查后7天内进行CT检查。对比增强超声检查中,评估动脉期和门静脉期的肝中静脉属支范围的肝实质的强化方式。采用肝中静脉属支闭塞常见的强化方式为标准,比较对比增强超声与多普勒超声检查对于肝中静脉属支闭塞的诊断效能,以CT检查作为参照。利用常用的估算公式对数据进行归类分析。结果在65例病人的148支肝中静脉属支中,CT检查中发现31例病人的36支(24.3%)闭塞。以动脉期高回声或门静脉期低回声作为诊断标准时,对比增强超声敏感度、特异度和准确度分别为91%(33/36)、97%(109/112)和95%(142/148);而多普勒超声分别为83%(30/36)、86%(97/112)和85%(127/148)。对比增强超声检查对于肝中静脉属支的闭塞较多普勒超声检查有更高的特异度和准确度(P=0.024和0.01)。动脉期高回声仅出现在肝静脉闭塞组。结论对比增强超声检查有助于准确评价活体肝移植改良肝右叶肝中静脉属支的闭塞情况。对比增强超声较多普勒超声更具特异性,肝静脉闭塞时表现为受累区域的动脉期强化。     

彩色多普勒超声诊断肝移植术后下腔静脉栓塞及狭窄

目的:探讨彩色多普勒超声诊断肝移植术后下腔静脉栓塞及狭窄的价值.材料和方法:回顾性分析103例成人肝移植术后9例下腔静脉栓塞及狭窄的彩色多普勒超声表现.结果:超声发现下腔静脉栓塞7例,下腔静脉狭窄2例,均经血管造影、磁共振或临床证实.下腔静脉栓塞超声表现为吻合口及下腔静脉内部分或完全被等回声充填,彩色多普勒及频谱多普勒显示充填部分血流信号消失;下腔静脉狭窄的超声表现为吻合口血流紊乱且血流速度加快.结论:多普勒超声在肝移植术后下静脉栓塞及狭窄的诊断中具有重要的价值.     

多普勒超声在肝移植中的应用

目的: 探讨多普勒超声在肝移植中的应用价值.材料和方法: 对105例原位肝移植的患者分别于术前、术中和术后多次行彩色及频谱多普勒超声检查.结果: 20例出现排斥反应,多普勒表现为肝静脉频谱变钝,正向波消失,门静脉流速减低,肝动脉阻力指数增高.7例出现肝动脉并发症,其中2例狭窄,5例血栓形成,CDFI主要表现为肝动脉血流信号消失,肝静脉和门静脉充盈良好,经血管造影证实;CDFI发现下腔静脉狭窄1例,门静脉狭窄1例,经球囊扩张后,血流灌注恢复正常.结论: 多普勒超声对移植肝血流动力学的监测、手术中及术后并发症的早期诊断具有重要作用.     

多层螺旋CT测量肝体积在活体肝移植中的应用

目的 评价多层螺旋CT测量肝体积在活体肝移植的应用价值.方法 亲体肝移植供体和受体各18例接受了多层螺旋CT扫描,所有病例联合应用阈值法和层切法测量受体的全肝、供体的右半肝和左半肝叶体积,测量结果与术中实际肝体积进行对比.结果 多层螺旋CT测量的受体平均肝脏体积为1232.4 cm3 ,术中平均肝脏体积为1220.1 cm3;多层螺旋CT测量供体肝左叶及右叶平均体积分别为392.9 cm3、836.59 cm3,术中肝左叶及肝右叶平均体积分别为389.9 cm3、832.84 cm3 2种方法测量结果差异无统计学意义(P>0.05).结论 MSCT可以准确评价肝体积,为活体肝移植术前提供重要依据.     

Postoperative imaging of living donor liver transplantation complications

Background

There is no doubt that the role of Different diagnostic imaging is well established in the evaluation of patients who are being evaluated for potential liver transplantation but it plays a huge role in the success of transplanted liver operations. Technical advances in imaging equipment and techniques allow more accurate assessment of postoperative living donor transplantation complications.

双源CT灌注成像在活体肝移植后对移植肝的评价作用

 目的 探讨双源CT灌注成像在活体肝移植后对移植肝的评价作用。方法 招募解放军总医院第三医学中心2013-06至2018-11进行活体肝移植术后1个月经超声及CTA检查肝动脉无狭窄患者25例;术后3个月患者61例,其中肝动脉无狭窄25例,轻度狭窄13例,中度狭窄12例,重度狭窄11例;同时收集同时期因怀疑有肝脏肿瘤行CT灌注扫描,后经临床及影像证实无肿瘤的患者(25例)作为对照组。上述所有研究对象均行双源CT全肝灌注成像检查并测量肝动脉灌注量(hepatic artery perfusion,HAP)、门静脉灌注量(portal vein perfusion, PVP)、肝总灌注量(total liver perfusion, TLP)及肝动脉灌注指数(hepatic perfusion index, HPI)。同时补充检测肝动脉狭窄人群的谷丙转氨酶(alanine transaminase, ALT)。结果 与对照组人群[(0.28±0.13) ml/(min·ml)]相比,肝移植术后1个月无肝动脉狭窄人群HAP[(0.36±0.17) ml/(min·ml)]显著增高(P<0.05),术后3个月中度及重度肝动脉狭窄人群HAP显著降低[(0.12±0.09)ml/(min·ml),(0.06±0.03) ml/(min·ml),P<0.05]。中度及重度肝动脉狭窄人群HPI较对照组显著降低(0.07±0.05、0.03±0.02 vs. 0.23±0.16, P<0.05)。重度肝动脉狭窄人群PVP较对照组显著升高[(1.81±0.36)ml/(min·ml) vs. (1.23±0.62) ml/(min·ml),P<0.05])。在肝动脉狭窄患者中,ALT对数与HAP对数成线性相关。结论 双源CT能对活体肝移植患者术后的移植肝进行血流灌注评价,能够为临床提供更为精准的信息,提高患者后续治疗的准确性。     

Hepatic vein stenosis after living donor liver transplantation: evaluation with Doppler US

PURPOSE: To determine the spectral Doppler ultrasonographic (US) findings that would indicate hepatic vein stenosis after living donor liver transplantation (LDLT). MATERIALS AND METHODS: The authors retrospectively reviewed postoperative Doppler US images of the hepatic veins in 113 consecutive patients who underwent LDLT. Doppler US was performed 1-25 times (mean, 5.2 times) during 1-433 days after LDLT. Nineteen patients who were inadequate for analysis were excluded; thus, 94 patients (72 male patients and 22 female patients; mean age, 40 years) were included in the study. Patients with more than 10 mm Hg of pressure gradient between the hepatic vein and the inferior vena cava were considered to have substantial hepatic vein stenosis (stenosis group). Those without substantial stenosis (control group) included patients with no clinical or radiologic evidence of hepatic vein stenosis for at least 3 months after LDLT. The wave pattern and peak flow velocity of the hepatic veins were compared between the groups. RESULTS: Five patients (5%) had substantial hepatic vein stenosis: three had persistent monophasic wave patterns at all US examinations, and two had monophasic wave patterns at most US examinations and biphasic or triphasic wave patterns at 6- and 9-day follow-up examinations. In the control group, 52 (58%) of 89 patients had a persistent triphasic or biphasic wave pattern and 37 (42%) had a monophasic wave pattern at one or more US examinations; this included two patients with persistent monophasic wave patterns. A monophasic wave pattern was more frequent in the stenosis group than in the control group (P =.015). There was no significant difference between the velocities of the hepatic veins in the stenosis group (22.3 cm/sec +/- 9.6 [SD]) and those in the control group (37.5 cm/sec +/- 20.3) (P =.14). CONCLUSION: A persistent monophasic wave pattern on Doppler US images of the hepatic veins is suggestive of, but not specific for, substantial hepatic vein stenosis after LDLT. A persistent triphasic wave pattern on Doppler US images can exclude the possibility of substantial stenosis.     

Role of MRCP in assessment of biliary variants in living donor liver transplantation

Introduction

Liver transplantation can be done by three different methods: Cadaveric, heterotopic and living donor liver transplantation (LDLT). In LDLT usually the right lobe of a donor liver is transplanted into the patient after proper volumetric studies. The native patient bile ducts are connected to the biliary tree of the transplanted liver segment.

Patients and methods

From January 2010 to August 2011, 50 potential LDLT donors were evaluated with preoperative MRCP.

Results

The radiologist evaluated the visualization of the common duct, right and left intra-hepatic ducts, and insertion of the right posterior lobe duct. The data were classified according to Huang and Hakki classifications. According to the more detailed classification of Hakki 13 patients (26%) were Type K1; 15 patients (30%) were Type K2a; three patients (6%) were Type K2b; 11 patients (22%) Type K3a; four patients (8%) were Type K3b; two patients (4%) were Type K4 and no patients were Type K5. Two patients with unclassified anatomical biliary pattern were encountered. In conclusion, this study has shown an extremely high accuracy of MRCP in preoperative assessment of live hepatic donors, which aided in the style and procedure of the operation and ultimately to a high success rate of the transplantation procedures.     

影像诊断及评估在儿童肝移植中的初步应用

目的:研究影像诊断在儿童肝移植中的作用.方法:对2004年12月～2005年8月本院4例儿童肝移植的影像诊断资料和手术记录进行回顾性分析比较,所有病例手术前后均行影像学检查,包括超声、CT、MRI和核素肝胆动态显像.结果:4例经病理证实,1例为肝母细胞瘤,2例为门静脉海绵状变性,1例为胆管闭锁.4例术前术后均行超声检查(包括多普勒),2例术前、1例术后行多层螺旋CT(MSCT)检查,1例术前行MRI检查,1例术前行核素肝胆动态显像(DRHI)扫描.超声在检出肝脏及肝脏血管病变的同时,还能动态显示肝脏血流,术后随访中作用尤其突出.MSCT、MRI与超声检查相比,图像视野大、三维立体感强,同时MSCT血管成像(MSCTA)及磁共振血管成像(MRA)均能清晰显示血管结构,DRHI在胆管闭锁的诊断中具有特异性.结论:所有病例的影像学诊断和临床表现在肝移植术的各期均高度一致,影像学诊断在肝移植术前手术计划的制订和术后随访中起重要作用.     

彩色多普勒超声对医源性股动脉假性动脉瘤的临床应用

目的：探讨彩色多普勒超声对医源性股动脉假性动脉瘤的诊断及治疗价值。方法对22例经皮股动脉穿刺介入术后触及搏动性肿块的患者采用二维超声、彩色多普勒超声、频谱多普勒超声检查,对声像图进行总结分析,在超声引导下压迫及注射治疗。结果本组22例假性动脉瘤彩色多普勒超声诊断与临床符合率100%（22/22）,18例经超声引导下压迫治疗后瘤腔闭合,3例经瘤腔内注射凝血酶治疗取得满意疗效,总治愈率95%（21/22）,1例行外科手术治疗。结论彩色多普勒超声是医源性假性动脉瘤首选的诊断及治疗方法。     

创伤骨折患者术前行血管超声检查及测定D-二聚体的意义

目的 回顾分析创伤骨折患者术前血管彩色多普勒超声检查诊断静脉血栓的价值及测定D-二聚体的意义,探讨D-二聚体与下肢静脉血栓的关系.方法 选择2008年3月-2009年4月因创伤致多发骨折、股骨骨折、胫骨或胫腓骨折当天入院,拟行手术切开复位术的1000例患者,其中男568例,女432例;年龄20～90岁[(54.8±21.50)岁].患者入院第2天清晨抽静脉血测定血清D-二聚体,拟行骨折复位术前1 d(骨折患肢消肿后,约骨折后4～10 d),行下肢血管彩色多普勒超声检查.结果 1000例患者行下肢血管彩色多普勒超声检查,64例(6.4%)存在下肢深静脉血栓,其中髂-股静脉血栓26例,胭-胫静脉血栓10例,肠腓肌、比目鱼肌血栓28例.骨折后2 d,1000例患者中有736例(73.6%)D-二聚体＞正常值(324μg/L),伤后4～10 d其中56例(7.6%)发生血栓;骨折后2 d,264例(26.4%)D-二聚体≤324μg/L,伤后4～10 d其中8例(3.0%)患者发生血栓;两组比较,差异有统计学意义(P＜0.01%).D-二聚体＞650μg/L的患者血栓发生率显著高于D-二聚体＜650μg/L的患者(P＜0.01).结论 创伤骨折术前行下肢血管彩色多普勒超声检查可降低麻醉手术期深静脉血栓引发致命性肺栓塞的风险.D-二聚体增高,可能引发血栓,但D-二聚体正常后也有发生血栓可能,不可忽视.     

Role of percutaneous radiological treatment in biliary complications associated with adult left lobe living donor liver transplantation: a single-center experience

PURPOSEBiliary complications develop at a higher rate in living donor liver transplantation (LDLT) compared with cadaveric liver transplantation. Almost all studies about biliary complications after LDLT were made with the right lobe. The aim of this study was to determine the frequency of biliary complications developing after adult left lobe LDLT and to evaluate the efficacy of the algorithm followed in diagnosis and treatment, particularly percutaneous radiological treatment.METHODSA total of 2185 LDLT operations performed in our center between May 2009 and December 2019 were retrospectively reviewed and patients receiving left lobe LDLT were analyzed regarding biliary complications and treatments. Biliary complications were treated via percutaneous drainage under ultrasound (US) guidance, endoscopic retrograde cholangiopancreatography (ERCP), and percutaneous transhepatic cholangiography (PTC)/percutaneous transhepatic biliary drainage (PTBD). Patient demographics, ERCP procedures before percutaneous treatment, and percutaneous treatment indications were analyzed.RESULTSA total of 69 adult patients received left lobe LDLT. Biliary complications requiring endoscopic and/or percutaneous treatment developed in 28 patients (40%). Of these patients, 4 had bile leakage (14%), 20 had anastomosis stricture (72%), and 4 had both leakage and anastomosis stricture (14%). External drainage treatment under ultrasound guidance was sufficient for 2 of 4 patients with bile leakage, and these cases were accepted as minor bile leakage (7%). Overall, 26 patients underwent ERCP; of these, 8 were referred for PTC/PTBD because the guidewire and/or balloon-stent could not pass the anastomosis stricture (n=7) and common bile duct cannulation could not be obtained because of duodenal diverticulum (n=1). Diagnostic PTC was performed in 10 patients, 8 were referred after inadequate/failed ERCP procedure and two were referred directly without ERCP. Anastomosis stricture was found in 7 patients and anastomosis stricture and bile leakage in 3. In 7 patients determined to have stricture, balloon dilatation was applied and then biliary drainage was performed. In 3 patients who had leakage and anastomosis stricture, balloon dilatation was applied for stricture; after dilatation, an IEBD catheter was placed through the leakage region in 2 patients, while a covered metallic stent passing through the leakage region was placed in one patient.CONCLUSIONGenerally, ERCP is the first preferred method in biliary complications of LDLT; however, in cases where a response cannot be obtained by endoscopic treatment or require complex and/or aggressive treatment, percutaneous radiological treatment should be the treatment of choice before surgery in left lobe LDLT.

Liver transplantation is a life-saving treatment method for end-stage liver disease and hepatocellular carcinoma (1–3). As cadaveric liver transplantation is limited, especially in Asian countries, or in situations where there is no time to wait for a suitable liver from a cadaver, living donor liver transplantation (LDLT) is an appropriate alternative method (4, 5). The first successful LDLT was performed by Strong et al. (6) in 1989, using segments 2–3 of left lobe in a child with biliary atresia. In 1993, Ichida et al. (7) performed adult-to-adult transplantation using the left lobe in a female with primary biliary cirrhosis. The firstright lobe LDLT was performed by Tanaka et al. (8) in 1994.Initially, because of the risks to the donor, left lobe transplantation was considered to be the only option in adult LDLT. However, as the left lobe grafts are thought to meet only 30%–50% of the metabolic needs of adult recipients, potentially leading to small-for-size syndrome, left lobe donation was limited (9). Although the current use of right lobe LDLT has resolved the problem of graft size in the recipient, it has caused an increase in the risks for donors. Recent studies have shown that left lobe LDLT have shifted the donor risks to the recipients (10).In previous studies, biliary complications in the recipient patient group have ranged as 10%–15% in cadaveric liver transplantation and 9%–37% in LDLT. Of the biliary complications that develop after LDLT, bile leakage constitutes 5%–19% and biliary stricture 4%–37% (11–14).The management of biliary complications includes endoscopic, radiological and surgical procedures. Endoscopic methods are generally the first step in treatment, and success rates after LDLT have been reported as 60%–75% in anastomotic strictures and 25%–33% in non-anastomotic strictures. Percutaneous radiological methods are the second step in treatment, with a reported success rate of 50%–75% (15).Almost all studies on biliary complications biliary complications following LDLT have been made with right lobe. The aim of the current study was to determine the frequency of biliary complications developing after adult left lobe LDLT and to evaluate the efficacy of the algorithm followed in diagnosis and percutaneous radiological treatment.     

Multi-slice computed tomography imaging of the post transplant complications in the recipients after living donor liver transplantation

Aim

To evaluate the clinical utility of MSCT in the detection and proper management of the different post-transplant complications in the recipients after LDLT.

Patients and methods

33 patients (28 males & 5 females) who underwent LDLT were referred to the Radiology department (CT unit) for evaluation of vascular, biliary, and parenchymal complications after LDLT using MSCT.

Results

Vascular complications were found in 16 cases (48.5%) [hepatic artery thrombosis (8 cases), hepatic artery stenosis (1 case), portal vein thrombosis (3 cases), portal vein stenosis (2 cases), hepatic veins stenosis (2 cases)]. Biliary complications were found in 9 cases (27.3%) [biloma (6 cases) 18.2%, biliary stricture (3 cases) 9.1%]. Hepatic abscess was found in 2 cases (6%), acute rejection was found in 2 cases (6%), recurrent HCC was found in 3 cases (9.1%). Neoplastic lympho-proliferative disorder was found in 1 case (3%).

Conclusion

MSCT is a non-invasive and accurate examination to detect complications after LDLT, it provides synchronous evaluation of the hepatic vasculature, biliary tract, liver parenchyma and the other abdominal organs in a single examination. MSCTA is the best option for confirming the US suspicion of vascular complications, with DSA reserved if therapeutic intervention is contemplated.     

彩色多普勒超声诊断下肢静脉疾病的临床价值——与DSA比较研究

目的 探讨彩色多普勒超声在下肢静脉疾病中的应用价值,并与DSA比较.方法 成用彩色多普勒超声仪对48例临床疑有下肢静脉疾病患者行二维彩色多普勒血流成像、脉冲多普勒及Valsalva试验等检查,并与DSA检查比较.结果 48例患者中有下肢深静脉血栓形成27例,其中15例合并下肢深静脉瓣膜功能不全,8例合并下肢浅静脉曲张,2例两者俱存,另有1例左侧腘窝囊肿合并腘静脉血栓,部分病例提示髂静脉流速减慢.单纯下肢静脉瓣膜功能不全5例,单纯下肢浅静脉曲张6例,6例两者俱存.4例超声检查正常,其中2例DSA提示有髂静脉受压.以DSA为诊断标准,诊断符合率为95.8%,两种方法行一致性检验,Kappa值为0.65.结论 彩色多普勒超声对下肢静脉疾病的临床诊断及疗效判断有重要的应用价值.