彩色多普勒超声监测肝移植术后门静脉并发症

Monitoring of portal vein complications following liver transplantation by color Doppler immage

目的 探讨彩色多普勒超声 (CDI)监测肝移植术后门静脉并发症的应用价值。方法 对 10 7例次原位肝移植患者于术前、术后应用CDI进行连续监测 ,监测指标包括门静脉主干内径、血流速度、血流量、血流频谱、侧支循环及腹水量等。结果 4例受者术后出现门静脉并发症 :门静脉狭窄 2例 ,门静脉狭窄并血栓形成 1例 ,门静脉右支闭塞 1例。 2例门静脉主干血流量明显减少者接受经皮腔内血管成形术治疗后 ,门静脉高压缓解 ;而CDI提示门静脉血流量未见下降的 2例患者 ,仅接受保守治疗 ,存活时间均超过 1年。结论 彩色多普勒超声动态检查对肝移植术后门静脉并发症较为敏感 。

Objective To explore the value of color Doppler image (CDI) in monitoring of portal vein (PV) complications following orthotopic liver transplantation (OLT).Methods Pre and post operative CDI examinations were performed on 107 orthotopic liver transplants. Monitoring parameters of CDI included: portal vein diameter (PVD), portal vein velocity (PVV), portal vein flow volume (PVFv), wave form and spectrum of PV, the presence of collaterals and ascites. Results A total of 4 ( 3.7% ) PV complications were identified by PV angiography in 107 recipients, including 2 cases of portal vein stenosis (PVS), 1 PVS combined portal vein thrombosis (PVT), 1 right portal vein (RPV) occlusion. Diagnostic sensitivity and specificity for PV complications of CDI were 100 % (4/4) and 98.1% (101/103), respectively. We performed percautaneous transluminal angioplasty (PTA) in 2 patients with PVFv remarkably reduced, and conservative treatment in 2 patients without PVFv reduced.Conclusion CDI is a sensitive and specific way of monitoring portal vein complications following OLT and also contributes to the treatment of portal vein complications. The conservative treatment might be effective for the patients with PVFv reduced unremarkably and the presence of collaterals, if not, PTA should be performed as early as possible.