彩色多普勒超声在肝移植术后肝动脉并发症的应用价值

目的　探讨彩色多普勒超声 (CDI)监测肝移植术后肝动脉并发症的应用价值。方法　术后连续CDI检查监测 180次原位肝移植。监测指标包括肝门部及肝内肝动脉左、右分支的峰值速度 (HAV) ,加速度 (HAAC) ,加速时间 (SAT) ,阻力指数 (RI) ,观察有无血流信号中断、侧支循环形成、肝内有无梗死灶和肝内、外胆管改变等。结果　 8例病人经选择性动脉造影证实为动脉并发症 (血栓形成 5例 ,肝动脉狭窄 3例 )。CDI表现有 :RI降低 <0 5 (8/ 8) ,SAT延长 >0 0 8s(6 / 8) ,HAAC降低<30 0cm/s2 (6 / 8) ,HAV降低 <4 0cm/s(7/ 8) ,肝内胆管扩张、回声改变等 (4 / 8) ,肝内梗死灶 (2 / 8) ,肝内外动脉血流信号消失 (2 / 8) ,肝门部侧支循环形成 (1/ 8)。CDI对动脉并发症诊断的敏感度和特异度分别为 87 5 % (7/ 8)和 95 3% (16 4 / 172 )。结论　CDI可有效监测肝移植术后肝动脉并发症并对其治疗有一定的指导作用。RI、SAT、HAAC、HAV是CDI诊断肝动脉并发症的敏感指标 ,联合应用可以提高CDI的诊断特异度。

Role of color Doppler imaging in diagnosis of hepatic arterial complications following liver transplantation

Objective To explore the value of color Doppler imaging (CDI) in diagnosis of hepatic arterial complications in liver transplant recipients. Methods CDI was performed in 180 patients receiving orthotopic liver transplantation. The parameters for CDI were hepatic artery velocity (HAV), hepatic artery acceleration (HAAC), systolic acceleration time (SAT), resistance index (RI), intrahepatic and extrahepatic arterial flow signal, arterial collaterals in the porta hepatis and biliary changes. Results A total of 8 HA complications including hepatic artery thrombosis (HAT) in 5 patients and hepatic artery stenosis (HAS) in 3 were identified by angiography. The findings by CDI included: RI less than 0.5 (8/8), SAT longer than 0.08s (6/8), HAAC less than 300 cm/s2 (6/8), HAV less than 40 cm/s (7/8), the absence of intrahepatic and extrahepatic arterial flow signal (2/8), visualization of arterial collaterals in the porta hepatis (1/8), intrahepatic parenchymal infarcts (2/8) and multifocal biliary dilatation (4/8). Diagnostic sensitivity and specificity of CDI for HA complications were 87.5% (7/8) and 95.3% (164/172), respectively. Conclusions CDI is a sensitive method for diagnosis of HA complications following liver transplantation and also contributes to the management. RI, SAT, HAAC and HAV are sensitive parameters for diagnosis of HAS or HAT. The analysis of these parameters together can achieve higher specificity.