床旁超声造影对肝移植术后早期肝动脉血栓的诊断价值  

Diagnostic value of bedside contrast-enhanced ultrasound for early hepatic artery thrombosis after liver transplantation

作　　者：廖梅[1] 张红君[1] 金洁玚 吕艳[1] 任杰[1] Liao Mei;Zhang Hongjun;Jin Jieyang;Lyu Yan;Ren Jie(Department of Ultrasound,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院超声科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2023年第6期630-634,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省自然科学基金面上项目(2015A030312013)。

摘　　要：目的探讨床旁超声造影(CEUS)在肝移植术后早期肝动脉血栓(HAT)评估中的诊断价值。方法本前瞻性研究对象为2016年3月至2020年3月在中山大学附属第三医院接受肝移植的585例受者。其中男516例,女69例;年龄0.5~78.0岁,中位年龄48.1岁。受者或其监护人均签署知情同意书,符合医学伦理学规定。移植术后1、2、3 d分别行床旁彩色多普勒超声(CDUS)及CEUS检查。对于术后4 d仍在ICU的受者,则按临床需要进行更多次的超声检查。HAT确诊以DSA或CT动脉造影(CTA)为金标准,采用ROC曲线评价诊断价值。结果585例肝移植受者中,CDUS检查肝内外动脉均未显示21例,CEUS发现其中12例肝内外动脉均无造影剂灌注,经DSA确诊为HAT;另外9例CEUS见肝动脉造影剂灌注,避免了DSA检查。CDUS在11例受者中可显示肝外动脉及一侧肝内动脉,经CEUS后可显示其中4例肝内动脉;余7例仍有一侧肝内动脉CEUS显示不清,在其后的超声随访中可显示这些肝内动脉。经CTA、超声、临床随访证实,床旁CDUS及CEUS均未漏诊HAT。CDUS诊断HAT的敏感度、特异度、Youden值、阳性预测值、阴性预测值分别为1.00、0.98、0.98、0.57、1.00,CEUS相应为1.00、1.00、1.00、1.00、1.00。两种方式诊断的ROC曲线下面积分别为0.992、1.000,差异有统计学意义(Z=3.021,P=0.003)。结论床旁CEUS可纠正CDUS的假阳性,提高肝移植术后早期HAT诊断的准确性,且避免DSA等有创检查。Objective To evaluate the diagnostic value of bedside contrast-enhanced ultrasound(CEUS)for early hepatic artery thrombosis(HAT)after liver transplantation(LT).Methods 585 recipients undergoing LT in the Third Affiliated Hospital of Sun Yat-sen University from March 2016 to March 2020 were enrolled in this prospective study.Among them,516 patients were male and 69 female,aged from 0.5 to 78.0 years,with a median age of 48.1 years.The informed consents of all recipients and/or their guardians were obtained and the local ethical committee approval was received.Bedside color Doppler ultrasound(CDUS)and CEUS were performed on the 1st,2nd and 3rd days after LT.For the recipients who stayed in ICU at postoperative 4 d,ultrasound examinations were more frequently performed according to clinical requirements.Digital subtraction angiography(DSA)or CT angiography(CTA)was the gold standard for the diagnosis of HAT.The diagnostic value was evaluated by the ROC curve.Results Among 585 recipients of LT,CDUS showed no intra-and extra-hepatic arteries in 21 cases,CEUS found no contrast perfusion in the intra-and extra-hepatic arteries of 12 recipients.The diagnosis of HAT was confirmed by DSA.In the remaining 9 cases,CEUS revealed contrast perfusion in the hepatic arteries,avoiding DSA.CDUS could display extrahepatic arteries and unilateral intrahepatic arteries in 11 recipients.Among 11 cases,CEUS could display intrahepatic arteries in 4 cases,whereas CEUS failed to clearly display unilateral intrahepatic arteries in the remaining 7 cases.Ultrasound during subsequent follow-up could display these intrahepatic arteries.CTA,ultrasound and clinical follow-up confirmed that neither bedside CDUS nor CEUS missed the diagnosis of HAT.The sensitivity,specificity,Youden's index,positive predictive value and negative predictive value of CDUS in diagnosing HAT were 1.00,0.98,0.98,0.57,1.00,and 1.00,1.00,1.00,1.00,1.00 for CEUS,respectively.The area under the ROC curve(AUC)of bedside CDUS and CEUS was respectively 0.992 and 1.000,and the d

关 键 词：肝移植 肝动脉血栓 超声检查 介入性 超声造影 

分 类 号：R657.3[医药卫生—外科学]