超声诊断小儿肝移植术后门静脉并发症的价值  

The value of ultrasound in diagnosis of portal vein complications in pediatric patients after liver transplantation

作　　者：任秀昀[1] 高农[1] 李威[2] 游波[2] 沈中阳[2] Ren Xiuyun Gao Nong Li Wei You Bo Shen Zhongyang(Department of Ultrasound Department of Transplant, General Hospital of Chinese People＇s Armed Police Forces, Beijing 100039, China)

机构地区：[1]武警总医院超声科,北京100039 [2]武警总医院移植科,北京100039

出　　处：《中华医学超声杂志（电子版）》2016年第9期641-645,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家高技术研究发展计划(863计划)(2012AA021006)

摘　　要：目的探讨超声诊断小儿肝移植术后门静脉并发症的价值。方法对2007年5月至2015年10月武警总医院实施的68例69次小儿肝移植受者术后进行超声多参数监测,评估门静脉并发症。超声测量参数包括:门静脉供受体段、吻合口及狭窄处直径,门静脉狭窄处上方及下方血流速度及脾脏大小。门静脉狭窄判断标准:狭窄直径比值>2倍,狭窄处上下方血流速度比值>4倍,且脾脏进行性增大;门静脉栓塞判断标准:门静脉管腔内见实性回声,彩色血流充盈缺损或消失。结果 69例次小儿肝移植受者,超声诊断门静脉并发症7例(10.1%,7/69),其中6例经CT血管造影或磁共振血管造影确诊。包括门静脉狭窄6例(8.7%,6/69),1例行球囊扩张术后恢复正常,其余5例经保守治疗后恢复正常;门静脉血栓1例(1.4%,1/69),因急性肝功能衰竭死亡。结论超声多参数测量可明确诊断小儿肝移植术后门静脉并发症。超声检查为小儿肝移植术后首选的影像学检查方法。Objective To explore the value of ultrasound in diagnosis of portal vein complications in pediatric patients after liver transplantation. Methods The ultrasonic multi-parameter monitoring was performed in 69 patients with liver transplantation in General Hospital of Chinese People′s Armed Police Forces from May 2007 to October 2015 to evaluate the complications. The parameters of ultrasonic measurement include： the diameter of portal vein at the donor segment, recipient segment, the anastomosis and the stenosis; the blood flow velocity above and below the portal vein stenosis; and the size of the spleen. The diagnostic standard of portal vein stenosis were： narrow ratio 〉2, the flow velocity ratio of above and below in the stenosis 〉4 and the spleen was enlarged after operation. The diagnostic standard of portal vein thrombosis were： echogenic thrombusin the main portal vein with lack of blood flow. Results In 69 cases of pediatric liver transplant recipients, portal vein complications were diagnosed in 7 cases（10.1%, 7/69）. All were confirmed by ultrasound. Six cases（8.7%, 6/69） had portal vein stenosis. Among them, 1 case were treated with balloon dilatation, and the remaining 5 cases recovered after conservative treatment. In addition 1 case（1.4%, 1/69） had portal vein thrombus, and finally died of acute hepatic failure. Conclusion Ultrasonic multi-parameter measurement can be used as a clear diagnosis method for the portal vein complications, which is the first choice for evaluating vascular complications after pediatric liver transplantation.

关 键 词：超声检查 肝移植 儿童 门静脉狭窄 门静脉栓塞 

分 类 号：R445.1[医药卫生—影像医学与核医学] R726.5[医药卫生—诊断学]