肝移植受者术后门静脉血流动力学的变化及其临床意义  

Changes in portal vein hemodynamics after liver transplantation and their clinical significance

作　　者：单瑞彩 王建红[1] 王宇[2] 李萌玫 杨子祯 吴晓冬[1] 李志强[1] 蔡金贞 Shan Ruicai;Wang Jianhong;Wang Yu;Li Mengmei;Yang Zizhen;Wu Xiaodong;Li Zhiqiang;Cai Jinzhen(Organ Transplantation Center,the Affiliated Hospital of Qingdao University,Qingdao 266035,China;Department of Abdominal Ultrasound,the Affiliated Qingdao Central Hospital of Qingdao University,Qingdao 266042,China;Department of Emergency Medicine,the Affiliated Qingdao Central Hospital of Qingdao University,Qingdao 266042,China)

机构地区：[1]青岛大学附属医院器官移植中心,青岛266035 [2]青岛大学附属青岛市中心医院腹部超声科,青岛266042 [3]青岛大学附属青岛市中心医院急诊科,青岛266042

出　　处：《中华肝胆外科杂志》2022年第6期430-434,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：青岛大学附属医院青年科研基金(QYFY-2021-36);北京肝胆相照公益基金会人工肝专项基金(RGGJJ-2021-027)。

摘　　要：目的通过彩色多普勒超声技术监测肝移植术后门静脉血流动力学参数变化,探讨其临床意义。方法回顾性分析2015年7月至2018年12月在青岛大学附属医院器官移植中心99例行肝移植手术受者的临床资料,其中男性81例,女性18例,年龄(51±9)岁。根据术后2年内是否发生门静脉并发症分为门静脉并发症组(n=23)和非门静脉并发症组(n=76)。另外选择同期于青岛大学附属医院体检的30名健康体检者作为对照组,其中男性16名,女性14名,年龄(40±14)岁。利用彩色多普勒超声观察肝移植术后1、7、14、30、180、365、730 d患者肝脏的形态,记录患者的门静脉最大血流速度、门静脉血流量。结果与正常对照组相比,非门静脉并发症组患者肝移植术后1、7、14、30、180 d的门静脉最大血流速度和门静脉血流量均增加,差异具有统计学意义(均P<0.05)。随着时间的延长,非门静脉并发症组患者门静脉最大血流速度及门静脉血流量呈递减趋势,至术后365 d,门静脉最大血流速度及门静脉血流量与正常对照组间差异已无统计学意义(P>0.05)。门静脉并发症组23例患者中,门静脉狭窄者9例,门静脉栓塞者14例。9例门静脉狭窄患者的门静脉最大血流速度63.8(46.0,78.6)cm/s高于非门静脉并发症组患者术后1个月的35.0(29.6,41.8)cm/s,差异具有统计学意义(Z=-3.35,P<0.001)。9例门静脉狭窄患者的门静脉血流量993(887,1168)ml/min高于非门静脉并发症组患者术后1个月的811(682,1018)ml/min,差异具有统计学意义(Z=-2.37,P=0.020)。结论肝移植术后门静脉最大血流速度及血流量术后早期均处于高水平,随着时间延长可恢复至正常水平。超声动态监测门静脉血流量变化对肝移植术后门静脉狭窄和门静脉栓塞的诊断具有重要临床价值。Objective To evaluate the ultrasound diagnostic value of portal vein complications after liver transplantation by monitoring changes in portal vein hemodynamic parameters using the color Doppler ultrasound technology and to determine its clinical significance.Methods The clinical data of 99 patients who underwent liver transplantation at the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from July 2015 to December 2018 were analyzed retrospectively.There were 81 males and 18 females,aged(51±9)years old.These patients were divided into the portal vein complication(n=23)and the non-portal vein complication(n=76)groups,based on whether portal vein complications had developed within 2 years after surgery.In addition,30 healthy volunteers at the Affiliated Hospital of Qingdao University,including 16 males and 14 females,aged(40±14)years old were selected to form the control group.The patients’morphology of liver was studied using color Doppler ultrasound at days 1,7,14,30,180,365 and 730 after liver transplantation,and the maximum portal vein blood flow velocity and portal blood flow were recorded.Results Compared with the control group,the maximum portal venous flow velocity and portal venous blood flow significantly increased on days 1,7,14,30,and 180 after liver transplantation in the non-portal complication group(all P<0.05).With time,these changes showed a decreasing trend.By day 365 after surgery,the differences between the maximum portal venous flow velocity and the portal venous blood flow between the two groups became not significant(P>0.05).Of the 23 patients in the portal vein complication group,9 developed portal vein stenosis(PVS)and 14 portal vein embolism.The 9 patients with PVS had a maximum portal flow velocity of 63.8(46.0,78.6)cm/s at 1 month after surgery,and this flow velocity was significantly higher than that in the non-portal complication group[35.0(29.6,41.8)cm/s,Z=-3.35,P<0.001].The portal blood flow was 993(887,1168)ml/min in the 9 patients with portal vein

关 键 词：肝移植 超声检查 多普勒 彩色 门静脉 血流动力学 手术后并发症 

分 类 号：R657.3[医药卫生—外科学]