肝移植术中超声检查对肝动脉并发症的应用价值

目的　探讨肝移植术中超声 (IOUS)对肝动脉并发症的应用价值。方法　对 2 6例肝移植受者施行IOUS检查 ,以峰值速度 (HAV) >4 0cm/s和阻力指数 (RI) >0 5为正常肝动脉的标准。结果　共施行 2 7例次IOUS检查 ,其中检查阳性 (HAV <4 0cm/s或RI <0 5 ) 7例次 ,经 0 5 %普鲁卡因浸泡 ,解除血管痉挛或再次吻合后 ,仍未能达到上述标准的 3例中术后出现HAT和HAS各 1例 ,其余病人术后均未出现肝动脉并发症。IOUS对动脉并发症诊断的敏感度、特异度、阳性预测价值和阴性预测价值分别为 10 0 % (2 / 2 )、96 % (2 4 / 2 5 )、6 6 7% (2 / 3)和 10 0 % (2 4 / 2 4 )。结论　IOUS对肝动脉并发症较高的诊断价值 ,吻合后肝动脉RI应大于 0 5 ,HAV应大于 4 0cm/s ,对于RI <0 5 ,HAV<4 0cm/s的病例在排除动脉扭曲成角和解除血管痉挛后仍不能达到上述标准者应重新吻合肝动脉。

Value of intraoperative ultrasonography for hepatic artery complications after liver transplantation

Objective To explore the value of intraoperative ultrasonography (IOUS) for hepatic artery complications following orthotopic liver transplantation (OLT). Methods IOUS was performed in 26 patients during OLT. The IOUS criteria of normal hepatic artery were RI>0.5 and HAV> 40cm/s. Results A total of 27 IOUS examinations were performed. Reliance on the detection of R and HAV as the criteria resulted in 7 positive IOUS. After acceptance of hepatic artery reconstruction or spasm relief with 0.5% procaine, 3 patients still had abnormal IOUS and HAT or HAS occurred in 2 of them following OLT. The diagnostic sensitivity, specificity, positive and negative predictive values of IOUS for hepatic artery complications were 100% (2/2), 96% (24/25), 66.7% (2/3) and 100% (24/24), respectively. Conclusions IOUS is of higher predictive value for hepatic artery complications following OLT. RI and HAV of hepatic artery should be more than 0.5 and 40 cm/s, if not, reconstruction should be performed.