超声和CT门静脉成像显示胆道闭锁婴幼儿活体肝移植术前门静脉通畅性的对比观察

Preoperative assessment of the portal vein in pediatric liver transplantation recipients:comparison of ultrasonography and spiral CT portography

目的比较超声与螺旋CT门静脉成像(SCTP)在评价胆道闭锁婴幼儿活体肝移植术前门静脉通畅性中的应用价值。方法对15例胆道闭锁患儿活体肝移植术前行超声和SCTP检查,超声观察门静脉管腔、管径、血流速度和方向及流速曲线形态,SCTP观察门静脉管腔、管径,并以术中解剖结果作为诊断标准,比较两者评估门静脉通畅性的准确性。结果15例患儿术前超声检查示门静脉管腔均通畅,管径平均为(4.37±0.76)mm(3.10～6.10mm);最大流速平均为(22.99±4.71)cm/s(16.40～32.60cm/s);血流方向向肝5例(33.33%),流速曲线形态为持续性单相带状,血流方向离肝10例(66.67%),流速曲线形态为规律的反相类动脉样改变。SCTP示门静脉管腔通畅9例,门静脉栓塞6例,管径平均为(4.14±0.78)mm(3.20～5.30mm)。术中证实门静脉管腔均通畅。超声与SCTP诊断门静脉通畅性的准确性分别为100.00%(15/15)和60.00%(9/15),两种检查方法的准确性差异有统计学意义(P<0.05)。结论超声对胆道闭锁婴幼儿术前门静脉通畅性评估的准确性明显高于SCTP,并且能进一步提供门静脉血流动力学方面的信息。

Objective To compare the value of ultrasonography and spiral CT portography （SCTP） in evaluation of the portal vein Jn pretransplant pediatric recipients. Methods Fifteen children with biliary atresia （BA） underwent ultrasonography and spiral CT portography before living donor liver transplantation. The lumen, caliber size, velocity, flow direction and waveform of the portal vein were evaluated with ultrasonography. The lumen and caliber size were evaluated with SCTP. According to the surgery, the accuracy of portal vein patency was evaluated. Results Ultrasonography showed portal vein patency in all 15 cases, with the mean portal vein caliber （4.37±0.76） mm （3.10-6.10 mm） and the max velocity （22.99 ± 4.71） cm/s （16.40-32.60 cm/s）. Ultrasonography showed normal hepatopetal flow in 5 cases, with the continuous flow pattern waveform and the other 10 cases were demonstrated with hepatofugal flow with regular similarly hepatic artery waveform. SCTP showed normal portal vein patency in 9 cases and portal vein embolization was noted in the other 6 cases. The mean portal vein caliber was （4.14±0.78） mm （3.20-5.30 mm）. The accuracy of uhrasonography and spiral CT portography in evaluating the portal vein patency was 100. 00% （15/15） and 60. 00% （9/15）, and the difference had statistically significant （P〈0.05）. Conclusion Uhrasonography has higher accuracy than that of spiral CT portography in children with biliary atresia undergoing living donor liver transplantation, and can provide more hemodynamics information about portal vein.