床旁彩色及脉冲多普勒(双功能)超声评估原位肝移植术后并发症

Bedside color and pulse Doppler (duplex) ultrasound for evaluating post orthotopic liver transplantation complications

目的观察床旁彩色及脉冲多普勒(双功能)超声评估原位肝移植(OLT)术后并发症的价值。方法回顾性分析65例接受OLT患者术后第1、3、7天床旁腹部双功能超声检查资料,评估肝脏实质回声及肝固有动脉及门静脉等血流束,测量门静脉峰值流速(PVPV)、肝动脉主干收缩期血流峰值流速(PSV)及血流阻力指数(RI)。根据腹部CT增强、CT血管成像(CTA)、超声造影(CEUS)、临床干预(包括增强免疫抑制剂和二次移植手术)或病理结果,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估以OLT后第7天内超声所测PSV(PSV_(第7天))及RI(RI_(第7天))判断有无并发症的效能。结果65例OLT后第1、3及7天,PVPV分别为71.00(45.50,96.50)、57.50(42.00,71.00)及50.00(33.00,66.00)cm/s,RI分别为0.68±0.16、0.69±0.17、0.66±0.13,各时间点间PVPV及RI差异均无统计学意义(H=5.475、P=0.065,F=0.964、P=0.501);PSV分别为63.00(44.50,89.00)、47.00(31.50,64.50)及50.00(38.25,64.75)cm/s,各时间点差异有统计学意义(H=7.313,P=0.026)。65例中,PSV正常46例、偏低(PSV<25 cm/s)1例、偏高(PSV>100 cm/s)18例;RI正常18例、偏低(RI<0.5)11例、偏高(RI>0.7)36例。36例出现OLT后并发症。以PSV_(第7天)诊断OLT后并发症的AUC为0.561,RI_(第7天)为0.699,PSV_(第7天)联合RI_(第7天)为0.732,与单独RI_(第7天)差异无统计学意义(Z=0.290,P>0.05)。结论利用床旁双功能超声监测移植肝动脉主干血流信号及RI可有效评估OLT后并发症。

Objective To explore the value of bedside color and pulse Doppler(duplex)ultrasound for evaluating post orthotopic liver transplantation(OLT)complications.Methods Data of 65 patients who underwent OLT and bedside abdominal duplex ultrasound were retrospectively analyzed.On the first day,the third day and seventh day post OLT,hepatic parenchymal echo and blood flow tracts such as proper hepatic artery and portal vein were observed,portal venous peak velocity(PVPV),peak systolic velocity(PSV)and resistance index(RI)of graft portal hepatic artery were measured.According to abdominal enhanced CT,CT angiography(CTA),contrast-enhanced ultrasound(CEUS),clinical intervention(including immunosuppressant enhancement and secondary transplantation)or pathological results,receiver operating characteristic(ROC)curve was drawn,and area under the curve(AUC)was calculated to evaluate the efficacy of PSV(PSV_(7th day))and RI(RI_(7th day))in the first week after OLT for diagnosing OLT complications.Results For all 65 cases,on the first day,the third day and seventh day after OLT,PVPV was 71.00(45.50,96.50),57.50(42.00,71.00)and 50.00(33.00,66.00)cm/s,respectively,RI was 0.68±0.16,0.69±0.17 and 0.66±0.13,respectively,both were not significantly different among different time points(H=5.475,P=0.065;F=0.964,P=0.501).Meanwhile,PSV was 63.00(44.50,89.00),47.00(31.50,64.50)and 50.00(38.25,64.75)cm/s,respectively,being significantly different among different time points(H=7.313,P=0.026).One week after OLT,normal PSV was found in 46 cases,while decreased PSV(<25 cm/s)and increased PSV(>100 cm/s)was noticed in 1 and 18 cases,respectively,whereas normal RI,decreased RI(<0.5)and increased RI(>0.7)was noticed in 18,11 and 36 cases,respectively.Post OLT complications occurred in 36 cases.AUC of PSV_(7th day) for diagnosing post OLT complications was 0.561,of RI_(7th day) was 0.699,and of PSV_(7th day) combined with RI_(7th day) was 0.732,and the latter was not significantly different with AUC of RI_(7th day) alone(Z=0.290,P>0.05).Conclusion Bedside duplex ultrasound could be used to monitor arterial flow signals and transplanted hepatic artery RI after OLT,hence effectively diagnose post OLT complications.