Prediction of hepatic artery thrombosis by protocol Doppler ultrasonography in pediatric living donor liver transplantation
Prediction of hepatic artery thrombosis by protocol Doppler ultrasonography in pediatric living donor liver transplantation
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DOI：
10.1007/s00261-003-0156-1
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发表时间：
2004-05
影响因子：
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通讯作者：
J. Kaneko;Y. Sugawara;N. Akamatsu;Yoji Kishi;Takashi Niiya;N. Kokudo;Masatoshi Makuuchi;K. Mizuta
中科院分区：
文献类型：
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作者：
J. Kaneko;Y. Sugawara;N. Akamatsu;Yoji Kishi;Takashi Niiya;N. Kokudo;Masatoshi Makuuchi;K. Mizuta
肝移植后肝动脉血栓形成（HAT）是危及生命的事件。先前的报告表明，肝动脉的阻力指数 (RI) 可预测 HAT。然而，用于测量 RI 的多普勒超声检查 (US) 并不常规进行。 研究对象是 70 名接受活体肝移植 (LDLT) 的儿科患者。术后 2 周，每天进行一次或两次多普勒超声检查，检查了 692 条记录。分别检查有和没有 HAT 并发症的患者 RI 值的变化。 HAT 的发生率为 10%（70 例中有 7 例）。 HAT 平均在 LDLT 后 6.2 天被诊断出来。在没有 HAT 并发症的患者 (n= 63) 中，LDLT 后 14 天的平均 RI 水平为 0.71 ± 0.1（记录，n= 625）。存在 HAT 并发症的患者，RI 在 HAT 发病前 2 天内逐渐下降。 RI 值小于 0.6 可预测发病前 2 天内的 HAT，敏感性为 83%，特异性为 85%。 LDLT 后前 2 周内的 RI 是 HAT 的敏感预测因子。当多普勒超声检查中 RI 值小于 0.6 时，应考虑血栓切除术和再吻合术。
Hepatic arterial thrombosis (HAT) after liver transplantation is a life-threatening event. Previous reports have suggested that the resistive index (RI) of the hepatic artery predicts HAT. Doppler ultrasonography (US) to measure RI, however, is not routinely performed. The subjects were 70 pediatric patients who underwent living donor liver transplantation (LDLT). Protocol Doppler US was performed once or twice a day for 2 weeks postoperatively and 692 records were examined. Changes in RI values were examined separately in patients with and without HAT complications. The incidence of HAT was 10% (seven of 70). HAT was diagnosed an average of 6.2 days after LDLT. In patients without HAT complications (n= 63), average RI levels at 14 days after LDLT were 0.71 ± 0.1 (records,n= 625). In patients with HAT complications, RI decreased gradually within 2 days before the onset of HAT. RI values of less than 0.6 predicted HAT within 2 days before onset, with 83% sensitivity and 85% specificity. RI during the first 2 weeks after LDLT is a sensitive predictor for HAT. Thrombectomy and reanastomosis should be considered when RI values are less than 0.6 in Doppler US.