超声检查对成人间右半肝活体肝移植桥静脉及其引流区域微循环灌注的动态观察

Dynamic observation of ultrasound examination for vein grafts and the relative parenchymal perfusion in adult-to-adult right lobe living donor liver transplantation

目的探讨常规超声和超声造影对成人间右半肝活体肝移植受者移植肝桥静脉及其引流区域微循环灌注的显像价值。方法选择2009年4月至9月浙江大学医学院附属第一医院连续实施右半肝活体肝移植并进行Ⅴ、Ⅷ段肝中静脉属支架桥的17例受者，于术后1个月内序贯进行桥静脉常规超声和移植肝超声造影检查，监测桥静脉血流情况，分析移植肝实质超声造影灌注表现。结果常规超声对17例受者的19根桥静脉显示良好。术后1d，13根桥静脉血流波形呈三相或二相波形，3根呈单向波形，3根未见彩色血流信号。术后1-2周，11根桥静脉血流波形呈二相波形，4根呈单向波形，4根未见彩色血流信号。术后1个月，10根桥静脉血流波形呈二相波形，5根呈单向波形，4根未见彩色血流信号。术后1～2周移植肝超声造影显示桥静脉引流区域的肝实质灌注表现多变，13例桥静脉未闭塞的受者中7例表现为V、Ⅷ段部分或全部肝组织动脉早期瞬间高增强，形状呈楔形或不规则形，实质期同步消退或提早消退；4例桥静脉闭塞的受者中3例表现为V、Ⅷ段肝组织全程低增强。结论常规超声结合超声造影可以对成人间右半肝活体肝移植桥静脉及其引流区域的微循环进行动态观察，为临床提供桥静脉通畅程度及其引流区域实质灌注的有效信息。

Objective To evaluate conventional and microbubble contrast-enhanced uhrasonography for assessment vein grafts and Ⅴ,Ⅷ segments perfusion after adult living donor liver transplantation （LDLT） with the right lobe. Methods A total of 17 cases of adult-to-adult right lobe LDLT without middle hepatic vein were retrospectively analyzed. Totally 19 reconstructed tributaries of middle hepatic vein and the relative parenchymal perfusion were investigated by conventional and contrast-enhanced ultrasonography. Results On Doppler ultrasound, there were no Doppler-detectable blood flow in 3 cases and monophasic waveforms in 3, biphasie or triphasic waveforms in the remains 13 postoperated day 1. Fifteen patients had enhancement difference in segments V and VIii of fight lobe on contrast-enhanced ultrasonography. One or two weeks after LDLT, 7 in 13 cases with normal graft veins were detected irregular hyper-enhancement at artery phase and iso-enhancement at portal and later phases in segments Ⅴ and Ⅷ of right lobe. Three in 4 cases with occluded graft veins were detected persistent hypo-enhancement in segments Vand Ⅷ of right lobe on contrast-enhanced ultrasonography.Conclusion Conventional ultrasonography is sensitive for the detection of vein grafts and contrast- enhanced ultrasonography is valuable to estimate the vein grafts relative parenchymal perfusion in recipients after LDLT using modified right lobe.