超声观察肝移植术后肝动脉与门静脉及胆管的价值

Value of Ultrasound in Detection of Hepatic Artery,Portal Vein and Bile Duct after Orthotopic Liver Transplantation

目的:探讨超声观察原位肝移植术(OLT)后肝动脉、门静脉与胆管在诊断与处理术后并发症中的临床价值。材料和方法:采用二维与彩色多普勒超声(CDFI)对6例OLT术后患者行超声随访(3～22个月),观察患者的肝、胆管、脾脏声像表现,检测肝动脉、门静脉的CDFI血流参数。检查次数6～20次。结果:4例OLT术后门静脉血流速度增大,其中2例肝动脉血流速度下降,阻力指数(RI)亦下降;1例肝动脉血流消失;1例肝动脉血流速由低速逐渐升高,RI亦明显增高,之后肝动脉血流消失。3例肝内出现低回声区。2例胆总管吻合口狭窄与闭塞。1例胆总管壁明显增厚。1例肝癌复发。结论:超声跟踪随访肝动脉、门静脉与胆管的变化对尽早发现OLT术后并发症,提高患者的生存率具有重要的临床意义。

Purpose ： In order to assist the post-operative management for patients after orthotopic liver transplantation （ OLT）, ultrasound was used in detection of hepatic artery and portal vein as well as bile duct. Materials and Methods： Six cases of OLT were followed up by 2D and color Doppler flow imaging （CDFI）. The sonograms of livers, bile duets and spleens were observed. The CDFI parameters of hepatic arteries and portal veins were assessed. The ultrasound procedures were repeated 6 - 20 times in 3- 22 month follow-up after the operation. Results ： Among the 6 cases, the velocity of portal venous flow was found increased in 4 cases after OLT. The velocity of hepatic arterial flow and the resistant index （RI） decreased in 2 cases. CDFI of the hepatic arterial flow disappeared in 1 case. The velocity of the hepatic arterial flow and RI increased gradually from low to high level but the CDFI disappeared later in 1 case. The low echo areas were found in 3 livers. Stenosis and obstruction of the stomas of the common bile ducts appeared in 2 cases. The wall of the common bile duct was obviously thick in 1 case. The hepatic carcinoma recurred in 1 case. Conclusion： Through the early discovery of the complications after OLT, the sonographic detection of the hepatic artery, portal vein and bile duct was proven of help in improving the management of the patients.