多模态超声在脑死亡器官捐献移植肝术后监测中的应用

Application of Multimodal Ultrasound in Post-operative Monitoring of Transplanted Livers by Donors after the Brain Death

目的联合应用二维灰阶超声、CDFI(彩色多普勒血流成像)、PW(频谱多普勒)及CEUS(超声造影)对脑死亡器官捐献肝移植术后实现灰阶、血流、微灌注等检查,探讨多模态超声在肝移植术后监测中的应用价值。方法选取2018年1月至2021年12月昆明市第一人民医院脑死亡器官捐献(donors after brain death,DBD)移植肝患者57例,所有患者肝移植术后均进行常规超声实时、动态连续监测,对移植肝血管显示困难、血流充盈差、可疑狭窄或血栓、移植肝内或肝周出现不能确定的异常病变进一步行CEUS检查,分析超声检查对移植肝术后各种并发症的诊断,检查结果与其他影像学检查、临床、病理、实验室检查进行对照。结果多模态超声提示有血管并发症者7例,其中肝动脉狭窄2例(3.5%),门静脉血栓2例(3.5%),下腔静脉血栓1例(1.2%),下腔静脉狭窄2例(3.5%);胆道并发症4例(7.0%):其中胆道狭窄3例(5.2%),胆汁瘤1例(1.2%),均经临床证实;一般常见并发症:胸腹腔积液57例(100%),肝内及肝周血肿31例(54.3%)。多模态超声漏诊肝动脉假性动脉瘤1例(1.2%)。结论多模态超声检查作为肝移植术后的首选检查方法,能较准确的诊断肝移植术后并发症。

Objective To explore the application value of multi-mode ultrasound in post-liver transplantation monitoring by combining two-dimensional gray scale ultrasound,CDFI,Spectral Doppler and CEUS in gray scale,blood flow and microperfusion examination after the liver transplantation.Methods In this study,57 patients with liver transplants donated by those after brain death(DBD)in our hospital from January 2018to December 2021 were selected.All the patients underwent the real-time,dynamic and continuous monitoring by conventional ultrasound after the liver transplantation.Results There were 7 cases of vascular complications,including 2 cases of hepatic artery stenosis(3.5%),2 cases of portal vein thrombosis(3.5%),1 case of inferior vena cava thrombosis(1.2%),and 2 cases of inferior vena cava stenosis(3.5%).There were 4 biliary complications(7.0%),including 3 biliary stenosis(5.2%)and 1 choleoma(1.2%),which were clinically confirmed.The common complications were pleural and abdominal effusion in 57 cases(100%),intrahepatic and perihepatic hematoma in 31 cases(54.3%).False aneurysm of hepatic artery was missed by multimodal ultrasound in 1 case(1.2%).Conclusion As the first choice after the liver transplantation,multimodal ultrasound can accurately diagnose the complications after the liver transplantation.