术中超声检查在活体肝移植手术中的应用价值

The value of intra-operative ultrasound in the living donor liver transplantation

目的探讨术中超声检查在活体肝移植供体、受体手术中的应用价值。方法对45例活体肝移植供体、受体进行术中超声检查。应用术中超声标记肝中静脉及其粗大属支走行;在切除供肝后检查残肝血流情况;肝脏植入后,检查植入肝脏血流情况。结果45例供体中,44例右半肝移植沿术中超声确定的肝中静脉入口成功切取移植物;1例左半肝移植沿肝左静脉入口成功切取移植物。术中超声诊断残肝门静脉血流不畅1例。45例受体中,术中超声诊断受体肝动脉栓塞3例,流出道梗阻2例,门静脉血流速度及血流量异常增高4例,门静脉吻合口狭窄1例。结论术中超声在引导切除供体肝脏、检测残肝血流及受体肝血流方面具有重要应用价值。

Objective To evaluate the value of intra-operative ultrasound in living donor liver trans- plantation. Methods The forty-five donors and recipients with living donor liver transplantation were performed by the intra-operative ultrasound using the Mylab 30 and Sequoia 512. The line of middle hepatic vein and its tributaries were marked by the intra-operative ultrasound. The blood flow and anastomosed vessels in both livers of donors and recipients were monitored after resected. Results The resected trans-plantations were successful according to the middle hepatic vein by the intra-operative ultrasound in the forty- four cases and one case in all 45 donors with transporation of right and left livers, respectively. One case of portal vein blood flow occlusion was found by intra-operative ultrasound. In the forty-five recipients, hepatic artery thrombosis in three cases, outflow occlusion in two cases, an abnormal increased portal vein blood flow velocity and hemodynamics in four cases, and portal vein anastomosis stenosis in one case were found by the intra-operative ultrasound. Conclusions The intra-operative ultrasound plays an important role in the resecring transplantation and monitoring blood flow of liver in donors and recipients.