超声对原位劈离式肝移植术前供肝评估价值初探

目的初步探讨超声对原位劈离式肝移植(ISSLT)术前供肝评估的价值。 方法回顾性分析5例脑死亡器官捐献供者接受供肝在体劈离术前的超声检查资料。5例供者术前均行常规二维超声、彩色多普勒超声和剪切波弹性成像检查，酌情行超声造影。 结果常规二维超声显示肝实质回声细小2例，略粗略强2例，增粗增强1例。5例供者肝内动脉、门静脉主干及其属支、肝中静脉及其属支彩色多普勒超声均显示良好。5例供者右肝前叶剪切波成像弹性值为2.67～4.35 kPa。2例供者行超声造影，1例未见异常，1例肝动脉解剖变异。术中所见肝脏血管情况与超声评估相符。病理结果示5例供肝肝小叶结构大致正常，均未见脂肪变性。 结论超声可以作为ISSLT术前供肝评估的首选影像学方法，了解供肝大小、质地、脂肪变性、血管变异等情况，剪切波弹性成像及超声造影从硬度、微循环灌注检测两方面进一步评估供肝质量，作为常规超声的有效补充。

Clinical value evalution of ultrasonography on liver grafts in in-suit split liver transplantation

ObjectiveTo preliminarily analyze the value of ultrasonography on liver grafts in in-suit split liver transplantation (ISSLT). MethodsThe ultrasonography data of 5 cases of donation after brain death were analyzed retrospectively. All the donors received routine two-dimensional ultrasonography, color doppler ultrasound (CDFI) and shear wave elastography (SWE) before transplantation, and contrast enhanced ultrasound (CEUS) was performed depending upon the situation. ResultsTest result of two-dimensional ultrasonography showed that liver echo was low in 2 cases, slightly enhanced in 2 cases, and remarkably enhanced in 1 case. No abnormality was found in hepatic artery, portal vein, middle hepatic vein or their branches using CDFI. The shear wave velocity of right hepatic anterior of 5 donors was 2.67-4.35 kPa. CEUS was performed in 2 donors, and 1 case had anatomical variation in hepatic artery. The vascular assessment results of ultrasonography were consistent with intraoperative findings. Pathologic findings showed no hepatic adipose infiltration in all five cases. ConclusionsUltrasonography can serve as the preferred imaging examanation for preoperative liver evaluation of ISSLT donor. It can accurately evaluate the size, quality, existence of adipose infiltration, and vascular variation of donor livers. SWE and CEUS can serve as effective supplements for the traditional ultrasonographic method by hardness and microcirculation perfusion detection, respectively.