婴幼儿活体肝移植后的血流动力学变化及血管并发症

目的 探讨婴幼儿活体肝移植术后的血流动力学变化及血管并发症的发生情况.方法 应用彩色多普勒超声观测34例婴幼儿活体肝移植术后2个月内门静脉、肝动脉、肝左静脉最大流速及肝动脉阻力指数变化情况,并观察术后血管并发症的发生情况及其预后.结果 34例受者中,术后超声显示血管通畅者29例(85.3%,29/34),发生血管并发症5例(14.7%,5/34).29例血管通畅的患儿,术后第1天时门静脉最大流速(vmax)为(53.97±21.44)cm/s,肝动脉收缩期最大流速(PSV)为(52.88±17.87)cm/s,阻力指数(RI)为0.73±0.09,肝左静脉最大流速为(40.53±25.07)cm/s.与术后第1天比较,术后1周时门静脉vmax、肝动脉PSV、肝左静脉vmax及肝动脉RI的差异均无统计学意义(P＞0.05);术后2周时门静脉vmax为(44.26±17.43)cm/s,明显低于术后第1天(P＜0.05);术后2个月时门静脉vmax为(40.31±26.29)cm/s,肝动脉PSV为(41.50±8.67)cm/s,均明显低于术后第1天(P＜0.01,P＜0.05).5例血管并发症均发生在术后7 d内,其中肝动脉血栓形成3例(2例行取栓术,1例行溶栓治疗),门静脉血栓形成2例(1例行取栓术,1例行溶栓治疗),5例中3例死亡.结论 婴幼儿活体肝移植术后门静脉vmax和肝动脉PSV呈下降趋势;血管并发症发生时间早,发生率较高,活体肝移植术后7 d内至少应每天进行1次超声检查.

Hemodynamic changes and vascular complications after pediatric living donor liver transplantation

Objective To evaluate the hemodynamic changes and vascular complications after pediatric living donor liver transplantation (LDLT).Methods The hemodynamic changes of the portal vein,the hepatic artery and the left hepatic vein of the 34 cases were evaluated by color Doppler ultrasound during 2 months after LDLT.The vascular complications after LDLT were also evaluated.Results Of the 34 cases,vascular complications occurred in 5 cases.One day after LDLT,the max velocity of portal vein was (53.97 ± 21.44) cm/s,the peak systolic velocity of hepatic artery was (52.88 ± 17.87) cm/s,the resistance index was 0.73 ± 0.09,the max velocity of left hepatic vein was (40.53 ± 25.07) cm/s.The parameters of the hemodynamics had no significant difference between 1day and 1 week after LDLT (P＞0.05).The max velocity of portal vein was decreased after 2 weeks (P＜0.05).After 2 months,the max velocity of portal vein and the peak systolic velocity were decreased (P＜0.01 and P＜0.05) compared to 1 day.Vascular thrombosis was found in 5 recipients and all occurred in the first week after LDLT.Hepatic artery thrombosis (HAT) occurred in 3 (8.8 %) cases,portal vein thrombosis (PVT) in 2 (5.9 %).Among the 5 cases,3 were died.Conclusion The max velocity of portal vein and the peak systolic velocity of hepatic artery were decreased gradually after LDLT.The vascular complications occurred in the early stage and had a relatively high rate.Doppler examination should be performed once every day within 7 post-transplant days.