成人活体肝移植肝中静脉搭桥后桥血管的超声显像

Ultrasound Imaging of Bridge Vessel Transplant Used to Reconstruct the Tributary of Middle Hepatic Vein in Living Donor Liver Transplantation

目的探讨彩色多普勒超声在成人活体肝移植(living donor liver transplantation,LDLT)肝中静脉搭桥后受体的桥血管显像中的应用。方法2005年12月至2006年7月我院25例患者接受右半供肝活体肝移植,术中用大隐静脉重建肝脏Ⅴ(V5)、Ⅷ(V8)段的肝中静脉粗大属支,静脉搭桥模式和例数为:单一V5(8例),两条V5(2例),V5和V8(9例),V8(6例),25例患者重建桥血管共36根。术后使用彩色多普勒超声对桥血管进行动态观察,随访7d至8月。结果彩色多普勒超声能显示成人活体肝移植肝中静脉搭桥后的桥血管;24例患者桥血管34支超声显示通畅,血管管径4.6～7mm,流速8.4～39.5cm/s。1例(2支)术后7d重建的静脉未探及血流,术后25d桥血管与右肝静脉形成侧枝循环。结论彩色多普勒超声可以准确显示肝中静脉搭桥后的桥血管,了解血管的通畅情况,测量其流速,为临床治疗提供详细、准确的信息。

Objective To discuss the application of color Doppler ultrasound in the imaging of bridge vein transplant used to reconstruct the tributary of the middle hepatic vein in adult living donor liver transplantation （LDLT）. Methods From December 2005 to July 2006, 25 patients underwent the adult living donor liver transplantation with right lobe grafts without middle hepatic vein. Tributaries of middle hepatic vein larger than 5 mm were reconstructed with great saphenous vein. Types and numbers of reconstructed tributaries of middle hepatic vein were listed below： single V5 （n=8）, double V5 （n=2）, the V5 and V8 （n=9）, V8 （n=6）. The successive investigation of the vein grafts was performed by color Doppler ultrasound in the period of from postoperative 7 days to 8 months. Results All vein transplants were detected by color Doppler ultrasound. Among them, 34 vein transplants of 24 cases undergoing adult LDLT appeared patent, but one case was suspected to have reconstructed finally the bypass vessels for blood circle regardless of the grafted bridge vein probably occurring the thrombosis. Conclusion Color Doppler ultrasound can precisely detect and appear the postoperative bridge vessel grafted, and also measure the blood flow velocity in grafted vein used to reconstruct the tributaries of the middle hepatic vein in LDLT.