超声造影评价儿童活体肝部分移植术术中及术后血栓形成的应用价值

Evaluation of thrombosis by using contrast enhanced ultrasound in and after the pediatric living donor liver transplantation

目的使用超声造影技术评价儿童活体肝部分移植术(LRLT)术中及术后血栓形成。方法 2015年3至10月上海市第一人民医院行LRLT亲体肝移植术(左半肝)的终末期肝病患儿5例。患儿分别于术中及术后进行超声造影以评价血管内血栓形成情况。结果 5例患儿全部接受亲体LRLT。1例患儿术后第2天因多脏器功能衰竭而死亡。术中超声造影诊断肝动脉血栓形成患儿1例,取栓后再次超声造影提示肝动脉显影微弱;1例患儿同时发生门静脉血栓及肝动脉血栓,取栓后肝动脉及门静脉皆显影良好;1例患儿肝动脉显影微弱,术中于肝动脉侧支插管注入含碘造影,提示肝动脉吻合口痉挛,供肝内肝动脉血管树显影。术后超声造影提示肝动脉血栓形成患儿1例,2次数字减影血管造影(DSA)及溶栓后超声造影提示肝动脉显影微弱;1例患儿门静脉血栓形成,抗凝治疗后第6天CT血管造影提示门静脉通畅。结论超声造影可及早发现LRLT术中及术后血栓形成,便于术中纠正及术后及时采取抢救措施。

Objective Evaluation of thrombosis by using contrast enhanced ultrasound（CEUS） in and after the pediatric living donor（liver transplantation LRLT）. Methods From March 2015 to October 2015, 5 pediatric patients（age range, 4 to 98 months） received the LRLT surgery（left lobe） in Shanghai General Hospital. Intraoperative and postop CEUS was used to evaluate the thrombosis in liver graft. The CEUS was performed to monitor thrombosis after LRLT. Results All 5 cases received LRLT surgery, 1 patient died of severe multiple organ failure on the first postoperative day. By using intraoperative CEUS, 1 patient was diagnosed of hepatic artery thrombosis and a weak enhanced hepatic artery after a embolectomy; 1 patient was diagnosed of simultaneous hepatic artery and portal vein thrombosis. After the embolectomy, the hepatic artery and portal vein displayed well. 1 case of hepatic artery weak display was detected,and hepatic artery spasm was proved on arteriography. After LRLT, 1 case of hepatic artery thrombosis was diagnosed, the patient displayed a weak hepatic artery enhancement after thrombolysis treatment; 1 case of portal vein thrombosis were detected. Six days after anticoagulant therapy, the CT angiography showed a portal vein patency. Conclusion The CEUS could accurately evaluate the thrombosis in and after LRLT.