Intraoperative Doppler Ultrasound in Liver Transplantation
Intraoperative Doppler Ultrasound in Liver Transplantation
复制标题
肝移植术中多普勒超声
DOI：
10.1177/875647939801400616
复制
发表时间：
1998
影响因子：
0.3
通讯作者：
Shigeru Goto
中科院分区：
文献类型：
--
作者：
Yu;Tung‐liang Huang;Chao;T. Lee;Tai‐yi Chen;Y. Chen;Po;Chiang Cheng Yuan;H. Eng;Chi;Hok Kim Cheung;B. Jawan;Shigeru Goto
本研究的目的是确定术中多普勒超声在肝移植血管并发症诊断和减少中的应用。本研究包括19名儿童和5名成人患者。在儿科组，12例患者接受活体相关肝移植（LRLT）， 2例分离肝移植（SLT）， 3例缩小肝移植（RLT）和2例全尺寸儿童肝移植（FPLT）。术中多普勒超声（US）观察移植物再灌注后肝静脉、门静脉和肝动脉血流动力学及波形。9例血流动力学不理想，包括肝静脉流量减少（6- 9cm /s），无脉动波形平坦（成人2例，LRLT 2例）；门静脉血栓形成（LRLT, n = 1）；门静脉血流减少（8 mL/min/kg） （LRLT, n = 1）；门静脉阻塞（SLT, n = 1）；动脉血流不良伴动脉波形减弱（FPLT, n = 2）。这些异常都通过外科手术成功重建，移植成活率达到100%。1个月后发现肝静脉血栓和复发性门静脉狭窄合并脾肾分流2例晚期血管并发症。手术取栓、经皮球囊扩张及金属线圈栓塞治疗均有效。3例患者死于非血管并发症，所有接受LRLT的患者均存活，总生存率为87.5%。综上所述，术中多普勒超声可以有效地检测到异常的肝脏血流动力学，从而允许早期干预，从而为患者提供更好的预后。在多普勒超声引导下密切监测重建过程，直到建立合适的流量和波形。这减少了移植后的血管并发症，从而消除了可能需要再次移植的致命并发症的可能性。
The purpose of this study was to determine the utility of intraoperative Doppler ultrasound for the diagnosis and reduction of the vascular complications in liver transplantation. This study included 19 pediatric and 5 adult patients. In the pediatric group, 12 patients received living related liver transplantation (LRLT), two splitting liver transplantation (SLT), three reduced-size liver transplantation (RLT) and two full-size pediatric liver transplants (FPLT). The hemodynamics and waveform of the hepatic vein, portal vein and hepatic artery were evaluated by intraoperative Doppler ultrasound (US) after reperfusion of the graft. Unsatisfactory hemodynamics was identified in nine cases, including decrease hepatic venous flow (6-9 cm/s) with non-pulsative flat waveform (adults, n = 2 and LRLT, n = 2); portal vein thrombosis (LRLT, n = 1); decrease portal flow (8 mL/min/kg) (LRLT, n = 1); occlusion of the portal vein (SLT, n = 1); poor arterial flow with dampened artery waveform (FPLT, n = 2). These abnormalities were all successfully re-reconstructed by surgical procedures and achieved a graft survival rate of 100%. Two late vascular complications including hepatic venous thrombosis and recurrent portal vein stenosis with splenorenal shunt were discovered 1 month later. They were treated effectively by surgical thrombolectomy and percutaneous balloon dilatation and metallic coils embolization respectively. Three patients died of non-vascular complications and all patients who underwent LRLT survived with a resultant 87.5% overall survival rate. In conclusion, intraoperative Doppler US is efficient in detecting abnormal hepatic hemodynamics, which permits early intervention and hence a better prognosis for the patients. Re-reconstructive procedures were monitored closely under Doppler US guidance until proper flow and wave-form were established. This reduces post-transplant vascular complications and thereby eliminates the likelihood of a lethal complication that might call for re-transplantation.