摘要
目的探讨超声评估儿童肝移植术后门静脉狭窄的血流动力学特点及其诊断价值。方法回顾性分析220例儿童肝移植术后门静脉常规超声检查结果。用以下公式评估门静脉狭窄情况:吻合口直径狭窄率(SR)%=(狭窄前直径-狭窄处直径)/狭窄前直径,SR>50%为直径狭窄诊断临界点。吻合口速度变化率(VR)%=(狭窄处流速-狭窄旁流速)/狭窄旁流速,VR>3为速度狭窄诊断临界点。将符合上述指标患儿同门静脉指标正常的肝移植患儿进行对比,并同门静脉数字减影血管造影(DSA)或增强重建CT进行对比。结果超声显示共有37例患儿SR>50%且VR>3(37/220=16.8%),同门静脉指标正常肝移植患儿对比差异有统计学意义(P<0.05)。经造影或CT重建确诊门静脉狭窄患儿共有30例,超声诊断门静脉狭窄直径和流速的敏感度和特异度分别是97.3%,83.3%和98.6%,83.3%,截断点分别是3.5 mm和157.5 cm/s。结论超声是非常有效、方便的检测儿童肝移植术后门静脉情况的影像学随访方法。超声检测门静脉吻合口直径和流速均具有较高的敏感度,但是特异度较低。
Objective To evaluate the hemodynamics of postoperative portal vein stenosis（PVS） and the diagnostic efficiency of Doppler sonography in pediatric living donor liver transplantation.Methods We retrospectively reviewed doppler sonography examinations results of 220 postoperative living donor liver transplantation.The morphologic narrowing at the anastomotic site（AS） of the PVS was analyzed.We calculated the PV stenotic ratio（SR） using the following formula：SR（%） = PRE-AS/PRE（PRE = pre-stenotic caliber）,an SR〈50% was defined as the critical point for PVS.We also calculated the velocity ratio（VR） between the AS and 2 cm away from AS,and set the significant VR as〉3.Then compare the parameters mentioned above with normal living donor liver transplantation contemporaneity.Statistical analyses were carried out to determine clinical significance of Doppler sonography diagnosed of portal vein stenosis of anastomotic versus portography or multidetector computed tomography（MDCT）.Results There were total 37 cases（16.8%） in this series with SR〉50% and VR〉3 and have evident statistical differences versus normal group.There were total 30 cases PVS diagnosed by portography or MDCT.Using the definition of morphologic PVS by Doppler sonography,the sensitivity and specificity of diameter and velocity of anastomotic were 97.3%,83.3% and 98.6%,83.3% respectively,and the cut-off value were 3.5 mm,157.5 cm/s respectively.Conclusion Doppler sonography is convenient and efficient imaging modality to detect and follow-up postoperative PVS in pediatric living donor liver transplantation.The Doppler criteria of diameter and velocity of anastomotic are both sensitive but specificity is low.
出处
《临床和实验医学杂志》
2016年第24期2429-2432,共4页
Journal of Clinical and Experimental Medicine
基金
北京市医管局临床医学发展专项(XM201302)"儿童活体肝移植临床技术创新"
关键词
儿童
肝移植
门静脉狭窄
多普勒超声
血流动力学
Children
Liver transplantation
Portal vein stenosis
Doppler Sonography
Hemodynamics
