慢性终末期肝病肝移植后肝脏血流动力学的CT灌注成像评价

Assessment of Hepatic Hemodynamics with Dynamic Computed Tomography in Endstage Liver Disease after Transplantation

目的 通过对比慢性终末期肝病在肝移植后与正常人群肝脏灌注参数的差异 ,评价CT灌注成像在肝移植术后肝脏血流动力学的价值。进一步了解慢性终末期肝病肝移植后血流动力学变化的规律。资料与方法 通过单层螺旋CT测得 9例慢性终末期肝病肝移植后 (术后 12～ 2 0d)和 13例正常人群的肝脏灌注参数 (肝动脉灌注量、门静脉灌注量、总灌注量以及肝动脉灌注指数 )。并统计分析两组数据之间的差异。结果 肝移植组和对照组的灌注参数分别是 :肝动脉灌注量 :(0 .3831± 0 .175 4 )ml·min-1·ml-1和 (0 .2 82 7± 0 .0 971)ml·min-1·ml-1;门静脉灌注量 :(1.5 76 3± 0 .4 5 4 0 )ml·min-1·ml-1和 (1.1885± 0 .3899)ml·min-1·ml-1;肝总灌注量 :(1.95 94± 0 .5 72 7)ml·min-1·ml-1和 (1.4 712± 0 .4 4 5 1)ml·min-1·ml-1;肝动脉灌注指数 :HIP 19.5 1%和 18.97%。对比对照组 ,肝移植组门静脉和总灌注量明显上升 (P =0 .0 4 4和 0 .0 36 )。结论 在慢性终末期肝病肝移植后早期 ,门静脉和总灌注量呈现明显上升趋势。肝动脉灌注量变化不明显 ,但其个体间变化增大 ,提示在术后早期肝动脉灌注量存在不稳定的变化过程。

Objective To assess values of hepatic perfusion after liver transplantation by dynamic helical computed tomography, and to explore changes in hepatic hemodynamics after liver transplantation by compare the result of control group.Materials and Methods Dyanmic computed tomography parameters were evaluated in 9 patients with liver transplantation for end stage liver disease and in 13 controls. Arterial, protal venous,total hepatic perfusion, the hepatic perfusion index (HPI) were calculated with the smoothing procedure. The examinations of study group were performed in 12～20 days after liver transplantation. Results Hepatic perfusion parameters of transplanted and control group assessed with dynamic computed tomography respectively, were as follows: arterial, (0.383±0.1754) ml·min -1·ml -1 and (0.2827±0.0971) ml·min -1·ml -1; portal venous, (1.5763±0.1754) ml·min -1·ml -1 and (1.1885±0.3899) ml·min -1·ml -1 ; total perfusion, (1.9594±0.5727) ml·min -1·ml -1 and (1.4712±0.4451) ml·min -1·ml -1; HPI 19.51% and 18.97%. The differences were significant for the portal venous and total hepatic perfusion after liver transplantation (P=0.044 and 0.036).Conclusion A high portal perfusion was present in early stage after transplantation in end stage liver disease. Hepatic arterial perfusion of transplanted patients is not significant difference with normal, but the deviation is existed due to varity in individuals.