实时超声弹性成像技术对原位肝移植患者术后缺血型胆道病变临床评估价值分析

Clinical application of real-time ultrasound elastography in the evaluation of ischemic biliary lesions in patients with orthotopic liver transplantation

目的探讨应用实时超声弹性成像技术对原位肝移植术后缺血型胆道病变的临床评估价值。方法 2013年1月～2017年1月在我院接受肝移植患者52例,使用彩色多普勒超声和实时超声弹性成像技术检测门静脉最大截面直径(PVD)、肝动脉阻力指数(HARI)、门静脉流速(PVV)、肝动脉搏动指数(HAPI)、肝动脉收缩期峰值流速(HAV),并测量剪切波速度(SWV)。结果术后6个月复查,胆道病变患者超声检查主要表现为与门静脉左右支伴行的肝内胆管呈管状等回声,彩色多普勒血流成像显示胆管低回声旁门静脉血流信号明显变细;在52例患者中发现缺血型胆道病变10例(19.2%);胆道病变与无胆道病变患者PVV、HAV、HARI和HAPI比较,差异无统计学意义(P>0.05),胆道病变患者PVD显著高于无胆道病变者[(1.1±0.2) cm/s对(0.8±0.3) cm/s,P<0.05];两组血清AST水平差异无统计学意义(P>0.05),但胆道病变患者血清ALP和GGT水平显著高于无胆道病变者(P<0.05);在检测深度分别为4 m和5 cm时,胆道病变患者SWV显著高于对照组,差异均有统计学意义(P<0.05)。结论实时超声弹性成像技术在原位肝移植术后缺血型胆道病变的临床评估方面具有经济、方便、无创、易重复的特点,对病变的监测具有重要的临床意义。

Objective To evaluate the clinical application of real-time ultrasound elastography in the evaluation of ischemic biliary lesions(IBL)in patients with orthotopic liver transplantation(OLT).Methods 52 patients received OLT in our hospital between January 2013 and January 2017,and all of them were checked-up by ultrasonography and real-time ultrasound elasticity imaging to measure portal vein diameter(PVD),hepatic artery resistance index(HARI),portal vein velocity(PVV),hepatic artery pulsatility index(HAPI),hepatic artery peak systolic velocity(HAV)and shear wave velocity(SWV).Results There were 10 patients(19.2%)out of the 52 recipients having IBL at 6th month check-up postoperatively;there were no significant differences as respect to PVV,HAV,HARI and HAPI in the two groups(P>0.05),while the PVD in patients with IBL was higher than that in those without[(1.1±0.2)cm/s vs.(0.8±0.3)cm/s,P<0.05];there was no significant difference in serum AST level between the two groups(P>0.05),while serum ALP and GGT levels in patients with IBL were much higher than those in the control group(P<0.05);the SWVs in patients with IBL detected at 4 cm and 5 cm depth were much higher than those in the control group(P<0.05).Conclusion The real-time ultrasonic elastography is an economical,convenient,noninvasive and repeatable approach for the evaluation of IBL in patients after OLT,which might be of great importance in monitoring the biliary lesions.