原位肝移植术后血管并发症的早期诊断八例报告

目的 探讨原位肝移植术后血管并发症的监测和早期诊断,方法 回顾分析了本院53例原位肝移植术后血管并发症的监测和诊断方法,包括术后连续动态彩色多普勒超声检查、选择性血管造影及相关的临床特征观察,结果 本组15%（8/53）的患者出现了血管并发症;肝动脉血栓形成3例,肝动脉狭窄2例,腹腔动脉狭窄1例,下腔静脉狭窄2例（其中1例经尸体检查证实）,其余7例经选择性血管造影证实,彩色多普勒超声诊断血管并发症的灵敏度和特异度分别为100%（8/8）和98%（45/46）。结论 肝移植术后血管并发症的临床表现缺乏特异性,连续动态的彩色多普勒超声检查是监测和诊断血管并发症敏感且特异的方法,术后监测时间不应少于2个月,在临床表现与彩色多普勒超声出现血管并发症的可疑征象时,应及时行血管造影检查进一步明确诊断。

Early diagnosis of vascular complications following orthotopic liver transplantation

ObjectiveTo establish early diagnosis of vascular complications following orthotopic liver transplantation (OLT).MethodsThe surveillance and diagnosis making of vascular complications in 53 cases of OLT patients from April 1990 to June 2000 were carried out by color Doppler imaging (CDI), selective-angiography and analyzing relevant clinical features.ResultsThe incidence of vascular complication after OLT is 15%(8/53) including 3 cases of hepatic artery thrombosis, 2 of hepatic artery stenosis, 1 of celiac artery stenosis, and 2 of inferior vena cava stenosis. Diagnosis was confirmed by selective angiography in 7 cases and by autopsy in one. The sensitivity and specificity of CDI were 100%(8/8) and 98% (45/46) respectively. Conclusions Clinical feature of vascular complications following OLT lacks specificity. Continuous monitoring using CDI is a sensitive and specific method in the detection and diagnosis of vascular complications.Duration of surveillance should be no less than 2 months.