肝移植术后下腔静脉功能不全的超声诊断

Color Doppler diagnosis of insufficient inferior vena cava after orthotopic liver transplantation

目的探讨肝移植术后下腔静脉(IVC)功能不全的彩色多普勒超声表现。方法应用彩色多普勒超声检查123例原位肝移植术后病人,观测项目包括:下腔静脉内径(IVCD)、血流通畅度、腔内回声、肝静脉内径(HVD)、峰值血流速度(HVV)、频谱形态等,并与100例正常人对照。结果123例病人中,114例IVC功能正常,9例(7.3％)确诊为IVC功能不全。IVC功能正常组、功能不全组和正常人组IVCD分别为(1.0±0.5)cm、(0.2±0.1)cm、(1.4±0.4)cm,组间比较差异显著(P<0.01)。IVC功能不全的超声表现为:(1)IVC内径<0.4 cm(9／9)。(2)IVC血流异常,包括内无血流信号(4／9),狭窄处局部高速湍流、狭窄前后血流速度明显减低(5／9)。(3)HV血流异常:HV单相血流(8／9),HV扩张(4／9),HV血流减慢(4／9)。(4)其他由于IVC功能不全引起的表现:门静脉逆流(2／9),肾脏肿大(5／9),肾静脉血流减慢(5／9)。移植术后IVC功能不全的最重要超声表现是IVCD<0．4 cm+HV单向血流+IVC内无血流信号或局部高速湍流,HV扩张的检出可使IVC功能不全诊断的特异性提高。结论肝移植术后病人IVC较正常人狭窄,但IVC内径>0.4 cm时并不发生IVC功能不全,IVCD<0.4 cm+HV单向血流+IVC内无血流信号或局部高速湍流是超声诊断IVC功能不全的重要指标。

Objective To determine the value of color Doppler imaging for diagnosis of insufficient inferior vena cava （IVC） after orthotopic liver transplantation （OLT）. Methods The diameter of IVC and other liver blood flow dynamics were determined by color Doppler imaging in 123 patients after OLT. One hundred healthy adults were employed to serve as the control group. Results Of the 123 patients, 114 had normal IVC function and 9 （7.3%） had insufficient IVC. The average diameter of IVC were 1.0±0. 5 cm, 0.2±0. 1 cm and 1.4±0. 4 cm in the normal IVC group, insufficient IVC group and control group, respectively. There was significant difference among the 3 groups （P〈 0. 001）. The abnormal imaging manifestations in the insufficient IVC group included IVC diameter 0.4 cm （9/9）, loss of flow signal in IVC （4/9）, high and low IVC velocity （5/9）, loss of normal hepatic vein periodicity （9/9）, dilated HVD （4/9）, lower hepatic flow （4/9） and refluent portal vein flow （2/9）, enlarged kidneys 95/9） and lower kidney vein flow （5/9）. IVC diameter 〈 0. 4 cm, abnormal flow signal in IVC and loss of normal hepatic vein periodicity was the most important manifestation. The dilated HVD was a more specific manifestation. Conclusions IVC is narrower in patients after liver transplantation than in normal adults. The insufficient IVC does not occur in patients with the IVC diameter 〉 0. 4 crn. The IVC diameter〈0. 4 cm, low or lost IVC flow signal and loss of periodicity of hepatic vein flow are the most important manifestations for diagnosis of insufficient IVC.