肝移植术后早期超声检查中肝动脉阻力指数增高的影响因素与意义

Contributing factors and significance to high resistive index on Doppler sonography of the hepatic artery immediately after liver transplantation

目的探讨肝移植术后早期超声检查中肝动脉阻力指数增高的影响因素及其意义。方法回顾性分析73例肝移植术后患者的动态彩色多普勒超声检查资料,按术后动态监测获得的肝动脉阻力指数,将其分为阻力指数增高组和正常组,对比分析两组受体年龄、受体性别、手术因素(手术时间、冷缺血时间、热缺血时间、无肝期时间等)及术后各种并发症,包括血管并发症、胆道并发症、排斥反应等。结果73例患者中17例(23%)出现肝动脉阻力指数一过性增高。受体平均年龄偏大组更易发生术后肝动脉阻力指数增高现象(P=0.027);在器官保存过程中,供肝冷缺血时间越长术后发生肝动脉阻力指数增高的几率也越大(P=0.035),其他因素包括受体性别、手术时间、热缺血时间及无肝期时间等两组无明显统计学差异。两组术后并发症(包括血管并发症、胆道并发症及排斥反应)发生率无明显统计学差异。结论肝移植术后早期超声发现肝动脉阻力指数增高是很常见的现象,与受体年龄偏大及供肝冷缺血时间过长有关,与肝移植术后各种并发症无明显相关。

Objective To investigate the contributing factors and significance to high resistance flow at the hepatic artery detected on Doppler sonography immediately after orthotopic liver transplantation. Methods Seventy-three patients who were examined on Doppler sonography consecutively after liver transplantation were divided into the normal resistive index （RI） group and the high resistive index group according to the RI measured after surgery. Several variances including transplant recipients, surgical procedures and complication after surgery were investigated. Results Seventeen （23%） of the 73 patients showed a temporal high resistive index at the hepatic artery during the first three days after transplantation. Older recipient and extended preservation time showed a statistically significant effect on the occurrence of a high resistive index at the hepatic artery immediately after transplantation （P〈0.05）. Other variableness like gender of recipients, time of surgery, time of warm ischemia, showed no statistical significance. The incidences of bile duct complications, vascular complications and acute allograft rejection were not higher at the follow-up in patients with high-resistance flow than in those with normal flow. Conclusion High-resistance flow is freguently found in the Doppler sonography of hepatic artery during the period immediately after transplantation, and it is related to the recipient＇s age and the tine of ischemia. This finding has no prognostic value for early complications after surgery.