彩色多普勒超声在检测正常移植肝脏及其并发症中的应用价值

目的 探讨彩色多普勒超声在检测正常移植肝脏及并发症中的应用价值。方法 用彩色多普勒超声观察41例肝移植患者肝脏动、静脉血流变化及胆管、肝实质声像图改变。主要观察最大血流速度、时间平均血流速度、阻力指数及胆管的内径。结果 41例中17例（41．5％）发生移植物排斥反应，其彩色多普勒显像（CDFI）显示13例（76．4％）门静脉平均血流速度减低；15例（88．25％）肝静脉波幅降低，呈单相锯齿波或负二相波；9例（52．9％）肝动脉阻力指数升高；5例（29．4％）胆管轻度扩张。41例中5例（12．2％）肝动脉血栓形成，主要表现为门静脉周围检测肝动脉血流信号消失。检测中要注意操作技术及一些假阳性和假阴性影响因素。肝移植术后3例（17．3％）早期轻度胆管扩张，2周内恢复。20例（48．8％）胆管扩张明显并逐渐加重，原于胆管狭窄（2例）、胆管结石（15例）及其他（3例）。结论 彩色多普勒显像技术对正常移植肝脏的确定及并发症的检出具有重要价值；对提高术后存活率有重要意义。

The value of color Doppler ultrasonography in monitoring normal orthotopic liver transplantation and its complication

To evaluate the value of color Doppler ultrasonography in monitoring normal orthotopic liver transplantation and its complication. Methods Forty-one patients after orthotopic liver transplantation were examined by using color Doppler flow imaging to observe hepatic blood flow and change of ultrasonography of hepatic parenchyma and biliary duct. The measured indexes included the maximum blood flow velocity (Vmax), time-average blood flow velocity (TAV), resistance index (RI) and diameter of biliary duct. Results Seventeen patients (41.5 % ) suffered from liver allograft rejection. Decrease of Vmax of portal vein was detected in 13 of 17 patients (76. 4 % ); Low-amplitude of blood flow velocity of hepatic vein was detected in 15 of 17 patients (88.25 %) and they showed negative serrated wave or negative two waves; There was an increased hepatic arterial RI in 9 of 17 patients (52.9 %); Slightly dilated bile duct was found in 5 of 17 patients (29. 4 % ); Five of 41 patients (12.2 % ) with hepatic arterial thrombosis in the postoperative period showed disappearance of blood flow of hepatic artery around portal vein. Slight dilatation of intrahepatic biliary duct in the early period after liver transplantation was found in 3 patients (7.3 % ) and restored with 2 weeks. Twenty patients (48. 8 % ) showed dilatation of intrahepatic biliary duct. The causes of biliary duct dilatation included biliary stricture in 2 cases (20 % ), stone in 15 cases (75 %) and others in 3 cases (15 % ). Conclusion Color Doppler ultrasonography is valuable for monitoring normal liver transplantation and its complication.