原位移植肝术后监护期的超声图像和血流变化观察

目的探讨原位肝移植术后监护期内的超声图像特征和血流动力学变化。方法2例同种原位肝移植术后当天至12天每天定期超声检查，观察肝实质回声、捡测肝动脉、右肝静脉、门静脉多谱勒血流、观察其演变过程，以峰值血流速度时间变化曲线表示。结果（1）肝内回声：第1例术后3。7天肝实质回声显示增强，第8天回声开始恢复，至第12天回声恢复正常。另1例无明显回声改变。（2）肝动脉血流：肝动脉峰值血流速度在整个监护期较对照组测值慢。例1在术后1—6天、例2在术后3天内肝动脉峰值血流时间变化曲线处于高流速状态，后期的曲线较稳定；血流较高时频谱收缩期波峰相对高尖，曲线上升支较陡直，舒张期血流克盈良好，频谱无中断，血管阻力指数无明显异常改变。稳定期频谱形态似三角形。（3）门静脉血流速度变化较小。右肝静脉血流在第2天和第6天有降低，其余观测时间内血流较稳定。结论原位移植肝回声接近正常或有波动性增强。主要与排异反应有关。监护期肝动脉峰值血流速度较正常对照组减慢，但术后1-6天内峰值血流时间演变曲线处于较高流速状态。可能与肝动脉吻合口情况和排异反应有关。肝静脉、门静脉血流变化不明显或偶有波动性降低。

Ultrasonogram Characteristics and Flood Flow Variation in Post-operation Monitoring of Orthotopic Liver Transplantation

Objective To report the characteristics of ultrasonogram and the flood flow variation in post-operation monitoring of orthotopic liver transplantation.Methods Regular ultrasonograph was given to 2 cases having received orthotopic liver transplantation,and the echo of liver parenchyma was observed and the blood velocity of liver artery,right liver vein and portal vein were measured.Results(1)The echo:for Case 1,the echo displays reinforcement from the 3rd day to the 7th day post-operation,and the echo started to recover on the 8th day and became normal on the 12th day;the echo of Cases 2 showed no change.(2)Hepatic artery blood flow:the hepatic artery peak velocity in post-operation monitoring was obviously lower than the control;the curve of hepatic artery peak velocity was higher from the 1st day to sixth day for Case 1 and from 1st day to 3rd day for Case 2;when blood flow was higher,the peak of spectrum was taller and apexer,the spectrum in diastole is integral and unbroken,resistant index of the vessel was normal;in stabilizing phase,the form of spectrum was a proximal triangle;(3)The change of the portal veins velocity variation is comparatively small,the liver vein velocity was lower on the 2nd day and the 6th day,and in the other days,the velocity was stabilizing.Conclusions Almost normality and fluctuantly reinforcement of the echo of orthotopic transplanted liver are associated with rejection;the hepatic artery peak velocity in the whole ministering is obviously lower than the control;the higher curve of hepatic artery peak velocity from the 1st day to the 6th day in post-operation monitoring is associated with rejection of the operation anastomose;the flood flow of the liver vein and portal vein are normal or fluctuantly lower.