肝移植术后移植肝血流灌注异常的CT灌注研究

Evaluation of the graft hemodynamics after liver transplantation by CT perfusion

目的运用CT灌注成像（CTP）探讨肝移植术后肝脏血流灌注的影响因素。方法33例肝移植术后患者接受CT血管成像（CTA）及CTP检查。计算主动脉强化峰值的95％可信区间范围，排除此范围以外的病例。测量无并发症患者肝动脉灌注量（HAP）、门静脉灌注量（PVP）、总肝灌注量（TLP）及肝动脉灌注指数（HPI）的平均值及其95％可信区间范围，并在此基础上分析有术后并发症患者的肝脏血流灌注情况及上述各项指标的影响因素。结果29例患者纳入该研究，其中无术后并发症15例，有术后并发症14例。无术后并发症患者HAP、PVP、TLP和HPI的95％可信区间范围分别为（0．1509～0．3183）、（0．7223～1．3859）、（0．8367～1．7231）ml·min^-1·ml。和17．83％～31．63％。14例有并发症的患者中，HAP降低7例，其中肝动脉狭窄5例、脾大3例；HAP增高2例，均为中、重度门静脉狭窄患者。PVP减低13例，其中门静脉狭窄或闭塞8例、脾肾分流4例、脂肪肝2例；TLP减低12例，全部与PVP减低有关。仅2例HAP减低患者HPI减低。结论CTP技术通过定量测量肝动脉、门静脉血流灌注，能够无创性评价各种移植肝血流灌注异常，客观评价移植肝缺血的程度和类型，对指导临床治疗具有重要价值。

Objective To investigate the influence factors on the graft hemodynamics after liver transplantation by CT perfusion （CTP）. Methods Thirty three liver recipients received CT angiography （CTA） and CTP after liver transplantation. The cases would be excluded when their peak values of the aorta enhancement on time-density curves were out of 95% confidence level. The 95% confidence levels of the hepatic artery perfusion （ HAP）, portal vein perfusion （ PVP）, total liver perfusion （TLP） and hepatic perfusion index （HPI） were calculated based on the recipients without postoperative complications and named them as references to those with complication. Results Twenty nine recipients were enrolled in the study, 15 of them had no postoperative complication while the other 14 had. The 95% confidence levels of HAP, PVP, TLP and HPI on the 15 recipients without complications were （0. 1509 - 0. 3183 ）, （0. 7223 - 1. 3859）, （0. 8367 - 1. 7231 ） ml · min^-1· ml^-1 and 17.83% - 31.63%, respectively. In the 14 cases with complications, HAP decreased in 7 cases, 5 of them had hepatic artery stenosis and 3 of them had splenomegaly. HAP increased in 2 cases, both of them had portal vein stenosis. PVP decreased in 13 cases, 8 of them had portal vein stenosis, portal vein thrombosis or occlusion, 4 of them had splenorenal shunts and 2 of them had fatty liver. TLP decreased in 12 cases and coincident with PVP decreasing. Only 2 cases had HPI decreasing accompanied with HAP decreasing. Conclusion The hepatic blood perfusion through the hepatic artery and portal vein could be quantitatively measured non-invasively by CTP. The severity and the subtypes of the hepatic ischemia could be evaluated objectively, which is helpful for treatment guidance.