生化指标及多普勒超声检查变化规律在肝移植术后早期肝动脉血栓诊治中的研究

The study of biomarks and ultrosonic doppler in the diagnosis and management of early hepatic artery thrombosis after liver transplantation

目的探讨生化指标及多普勒超声检查变化规律在肝移植术后早期肝动脉血栓诊治中的应用。方法1例肝移植术后早期肝动脉血栓患者成功进行了血管重建及血管内介入治疗,回顾性分析治疗过程中相关生化指标及彩色多普勒超声检查变化的资料,结合国内外相关文献,总结肝移植术后早期肝动脉血栓治疗过程中生化指标及彩色多普勒超声检查变化的规律。结果患者肝移植术后第7天出现肝动脉血栓,谷丙转氨酶、谷草转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶均明显升高,其中γ-谷氨酰转肽酶最早在血栓确诊前3d即开始升高。胆碱酯酶在肝动脉血栓之后出现下降趋势。以上各种生化指标变化在血流恢复第2天后达到高峰,血流恢复后第3天开始下降。彩色多普勒超声提示在血栓形成前3d可探及门静脉流速明显增加。结论γ-谷氨酰转肽酶开始升高和/或者多普勒超声检查门静脉流速明显增加应考虑早期肝动脉血栓形成。

Objective To investigate biomarks and ultrasonic doppler in the diagnosis and management of early hepatic artery thrombosis after liver transplantation Method One patient with early hepatic artery thrombosis after liver transplantation successfully underwent vascular reconstruction and intravascular interventional therapy.The changes of biochemical indexes and color doppler ultrasound during the treatment were analyzed retrospectively.Combined with the relevant literature at home and abroad,the changes of biochemical indexes and color Doppler ultrasound during the treatment of early hepatic artery thrombosis after liver transplantation were summarized.Result The patient developed hepatic artery thrombosis,alanine aminotransferase,aspartate aminotransferase,alkaline phosphataseγ-Glutamyl transpeptidase increased significantly,among whichγ-Glutamyl transpeptidase began to increase as early as 3 days before the diagnosis of thrombosis.Cholinesterase decreased after hepatic artery thrombosis.The changes of the above biochemical indexes reached the peak on the second day after blood flow recovery,and began to decline on the third day after blood flow recovery.Doppler ultrasound could detect that the velocity of portal vein increased significantly 3 days before thrombosis.Conclusion Early hepatic artery thrombosis after liver transplantation should been considered whenγ-Glutamyl transpeptidase was rising and/or the inspection and measurement of biomarks and Subsequent ultrasonic doppler showed that the velocity of portal vein was rising.