CEUS: A new imaging approach for postoperative vascular complications after right-lobe LDLT

AIM: To investigate contrast-enhanced ultrasound (CEUS) for early diagnosis of postoperative vascular complications after right-lobe living donor liver transplantation (RLDLT). METHODS: The ultrasonography results of 172 patients who underwent RLDLT in West China Hospital, Sichuan University from January 2005 to June 2008 were analyzed retrospectively. Among these 172 patients, 16 patients' hepatic artery flow and two patients' portal vein flow was not observed by Doppler ultrasound, and 10 patients' bridging vein flow was not shown by Doppler ultrasound and there was a regional inhomogeneous echo in the liver parenchyma upon 2D ultrasound. Thus, CEUS examination was performed in these 28 patients. RESULTS: Among the 16 patients without hepatic artery flow at Doppler ultrasound, CEUS showed nine cases of slender hepatic artery, six of hepatic arterial thrombosis that was confirmed by digital subtraction angiography and/or surgery, and one of hepatic arterial occlusion with formation of lateral branches. Among the two patients without portal vein flow at Doppler ultrasound, CEUS showed one case of hematoma compression and one of portal vein thrombosis,and both were confirmed by surgery. Among the 10 patients without bridging vein flow and with liver parenchyma inhomogeneous echo, CEUS showed regionally poor perfusion in the inhomogeneous area, two of which were confirmed by enhanced computed tomography (CT), but no more additional information about bridging vein flow was provided by enhanced CT. CONCLUSION: CEUS may be a new approach for early diagnosis of postoperative vascular complications after RLDLT, and it can be performed at the bedside.

亲属活体肾供者肾小球滤过率与年龄的相关性及其临床意义

目的探讨亲属活体肾供者肾小球滤过率（GFR）与年龄的相关性及其临床意义，为活体肾供者的选择提供客观的依据。方法161名亲属活体肾供者按年龄分为4组：第1组20—29岁（n=52），第2组30—39岁（n=44），第3组40～49岁（n=38），第4组≥50岁（n=27）；同时以55岁为界，分为老年供肾组（〉55岁，n=24）和中青年供肾组（≤55岁。n=137）。利用^99Tc^m-二亚乙基三胺五乙酸肾动态显像法定量测量供肾者GFR，对比分析不同年龄组间GFR的特性。结果亲属活体供肾者双肾GFR为（89．55±12．87）ml·min^-1（1．73m2）^-1，不同年龄组（1～4组）GFR分别为：（88．27±12．29）ml·min^-1（1．73m2）^-1、（91．85±14．51）ml·min^-1（1．73m2）^-1、（89．25±11．26）ml·min^-1（1．73m2）^-1和（88．24±13．20）ml·min^-1（1．73m2），各组间GFR差异无统计学意义（F=2．09，P=0．10）；老年供肾组与中青年供肾组GFR分别为（88．57±13．14）ml·min^-1（1．73m2）^-1、（89．44±10．34）ml·min^-1（1．73m2），两组间GFR差异无统计学意义（F=1．31，P=-0．25）。经相关性分析，亲属供肾者GFR与年龄变化无明显相关性（r=0．033，P=0．69）。活体肾移植后供肾者均未发生严重并发症，血清肌酐、血清尿素氮均于短期内恢复正常水平，肝肾功能均正常。结论亲属活体肾供者GFR与年龄变化无明显相关性，对于指导活体供体的选择有重要意义。

数字医学技术在活体肝移植术前评估中的应用价值

活体肝移植的发展缓解了供肝不足和受体增加的矛盾,是目前治疗终末期肝病的最佳疗法。为保证肝移植手术的顺利进行及供、受体的安全性,术前供体肝脏体积评估以及了解肝内管道是否存在变异尤为重要。随着数字医学技术的不断发展,术前采用三维重建软件对供体肝脏进行个体化三维重建,测算肝脏体积、评估肝内管道以及进行虚拟手术,能够促进临床医生对肝脏空间结构的了解和对手术方案的评估,进一步保证了手术的安全性和可靠性,对于活体肝移植的术前评估有非常重要的临床意义。