摘要
目的分析总结肝移植术后肝动脉并发症伴侧支形成超声造影(CEUS)表现,探讨CEUS评价肝移植术后肝动脉并发症伴侧支形成的价值。方法 2004年4月至2011年12月中山大学附属第三医院肝移植中心所有肝移植术后常规超声或临床表现疑似肝动脉并发症行CEUS检查、并行数字减影血管造影(DSA)检查和(或)CT+CT血管成像(CTA)证实有及无肝动脉侧支形成患者30例。回顾性分析比较肝动脉并发症伴侧支与无侧支患者肝动脉CEUS表现。结果 30例肝移植患者中,11例CT+CTA和(或)DSA检查证实肝动脉有侧支,19例DSA检查证实肝动脉无侧支。肝动脉有侧支患者肝动脉并发症诊断时间晚于肝动脉无侧支患者[304 d(144～1917 d)vs 47 d(5～232 d),U=20,P<0.01]。11例肝动脉有侧支患者均有肝动脉并发症,且以肝动脉血栓多见(9/11,81.8%);而19例肝动脉无侧支患者肝动脉并发症以肝动脉狭窄多见(15/19,78.9%),有1例患者无肝动脉并发症;肝动脉有侧支和无侧支患者肝动脉并发症类型差异有统计学意义(Fisher精确概率法,P=0.001)。肝动脉有侧支患者临床表现多平稳,但常规超声检查发现多数病例胆管异常(10/11)。肝动脉侧支CEUS表现有一定特征:(1)肝固有动脉多不能显示(10/11);(2)肝门部多条细小迂曲的侧支动脉聚集,呈网状(5/11)或片状增强(6/11),伴细条状增强(2/11)。肝动脉无侧支患者除了3例肝动脉血栓外,肝固有动脉均可见显示,肝门部均未见除肝动脉以外的其他动脉。结论肝移植术后肝动脉并发症伴侧支形成CEUS表现具有一定特点,CEUS有可能成为诊断肝移植术后肝动脉并发症伴侧支形成的新方法。
Objective To summarize the contrast-enhanced ultrasonographic(CEUS) features of hepatic artery complication with collateral transformation after liver transplantation and to explore the diagnostic value of CEUS for collateral transformation of hepatic artery.Methods All 30 post-orthotopic liver transplantation patients suspected hepatic artery complication by color Doppler flow imaging or clinical manifestation were performed CEUS,digital subtraction angiography(DSA) and/or computed tomography combining computed tomography angiography(CT+CTA) at liver transplantation center of the Third Affiliated Hospital of Sun Yat-sen University between April 2004 and December 2011.Hepatic artery CEUS features of patients with collateral transformation of hepatic artery and patients without collateral transformation of hepatic artery were retrospectively compared.Results There were 30 post-orthotopic liver transplantation patients,including 11 patients with collateral transformation of hepatic artery confirmed by CT+CTA or DSA and 19 patients without collateral transformation of hepatic artery confirmed by DSA.The diagnostic time of hepatic artery complication in patients with collateral transformation of hepatic artery was significantly later than that of patients without collateral transformation of hepatic artery(144-1917 d,median 304 d vs 5-232 d,median 47 d,U=20,P<0.01).All 11 patients with collateral transformation of hepatic artery had hepatic artery complication and most of them were hepatic artery thrombosis(HAT) patients(9/11,81.8%);however,most of patients without collateral transformation of hepatic artery were hepatic artery stenosis(HAS) patients(15/19,78.9%) and one of them had normal hepatic artery.The distribution of hepatic artery complication types between two groups was significantly different(Fisher′s exact test,P=0.001).Patients with collateral transformation of hepatic artery hadn not evident clinical symptoms,but most of them showed bile duct abnormality(10/11) in conventional ultrosonography.Hepatic
出处
《中华医学超声杂志（电子版）》
2013年第5期374-380,共7页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
卫生部公益性行业专项基金(2007-02-10)
关键词
超声检查
造影剂
肝移植
肝动脉
手术后并发症
Ultrasonography
Contrast media
Liver transplantation
Hepatic artery
Postoperative complications
