彩超在减体积肝移植术后流出道梗阻的诊断及介入治疗中的应用

Application of color Doppler ultrasonography in diagnosis and interventional treatment of outflow occlusion after reduced sized liver transplantation

目的探讨彩色多普勒超声在儿童减体积肝移植术后流出道梗阻的诊断及介入治疗中的应用价值。方法2例儿童减体积肝移植术后流出道梗阻并发症病例,分析流出道梗阻的彩色多普勒超声表现及介入治疗前后的血流动力学改变。结果例1为肝静脉狭窄,超声表现为管腔直径不足2.5 mm,狭窄长度达15 mm,血流速度115.0 cm/s,同时伴大量腹水、脾脏增大。球囊括张术后血流速度轻度下降,1周后又重新恢复高速血流。支架植入术后血流速度降至正常范围,腹水消失。例2为下腔静脉狭窄,超声表现为下腔静脉肝后段内径明显变细、其直径不足0.3 mm,血流速度增快达200 cm/s以上。结论彩色多普勒超声对减体积肝移植术后流出道梗阻的诊断及监测介入术后血流动力学改变方面具有重要作用。

Objective To study the application of color Doppler ultrasonography in diagnosis and interventional treatment of outflow occlusion after reduced sized liver transplantation. Methods For two child patients having outflow occlusion ＇after RSLT, the changes in ultrasonography and hemodynamics after and before interventional treatment were analysed. Results One child had hepatic vein stenosis, which shoused by uhrasonography the vein less than 2.5 mm in dismeter, 15 mm in length, and as high as 115.0 cm/s in blood flow rate, acompanied with serious ascites and splenomegaly . After balloon dilatation, the blood flow in hepatic vein was slightly slower than before, and returned to previous state a week later. After a metallic stent was inserted, it displayed normal blood flow, and ascites disappeared, the other child had stenosis of inferior vena cava, which showed the posterior hepatic vena cava less than 3.0 mm in diameter, slenderer than inferior hepatic vena cava, and higher than 200 cm/s in flow rate.Conelusions Color Doppler ultrasography plays an important role in the diagnosis of outflow occlusion and monitoring the changes in hemodynamics following interventional treatment after reduced sized liver transplantation.