摘要
目的探讨儿童肝移植术后肝静脉流出道梗阻(hapatic venous outflow obstruction, HVOO)的超声诊断效能及随访要点。方法收集2017年7月至2022年1月于天津市第一中心医院经数字减影血管造影(digital subtraction angiography, DSA)检查确诊为肝移植术后流出道梗阻并接受球囊扩张治疗的儿童受者作为HVOO组(32例);选取无血管并发症的儿童肝移植受者作为对照组(30例)。记录彩色多普勒超声检查血流参数, 包括肝动脉收缩期峰值流速(peak systolic velocity, PSV)、舒张期流速(peak diastolic velocity, PDV)、收缩期峰值流速/舒张期流速(S/D)、阻力指数(resistance index, RI)、以及门静脉流速(portal vein velocity, PVV)、肝静脉流速(hepatic vein velocity, HVV)及波形、肝静脉与下腔静脉吻合口流速及波形, 同时记录48 h内DSA腔内测压值。分析扩管前后彩色多普勒血流参数与血管腔内测压值的相关性;比较HVOO组扩管前彩色多普勒超声血流参数与对照组的差异性并绘制ROC曲线, 得出各参数曲线下面积及临界值;选取恢复良好病例比较扩管前后彩色多普勒血流参数值的差异性, 分析血流动力学变化趋势。结果 HVOO组扩管前后肝静脉与下腔静脉吻合口流速值与DSA值均呈正相关(r=0.483和r=0.414, 均P<0.05);HVOO组S/D、阻力指数、吻合口流速高于对照组(Z=-3.275, P=0.001;t=3.437, P=0.001;Z=-5.677, P<0.01);HVOO组PVV、HVV低于对照组(Z=-2.719, P=0.007;Z=-6.762, P<0.01);HVOO组肝静脉及其吻合口波形以单相波为主, 分别占81.25%(26/32)和53.12%(17/32), 对照组均为双相波。根据ROC曲线分析显示HVV诊断HVOO的曲线下面积0.996, 临界值是21.65 cm/s, 肝静脉吻合口流速的曲线下面积0.92, 临界值是162 cm/s, 阻力指数的曲线下面积0.76, 临界值是0.73。扩管后PVV、HVV值均高于扩管前(Z=-2.233, P=0.026;Z=-4.45, P<0.01);扩管后吻合口流速值低于扩管前(t=8.584, P<0.01)。肝静脉及其吻合口波形�
Objective To explore the diagnostic efficacy of ultrasonography and follow-up outcomes of hepatic venous outflow obstruction after liver transplantation(LT)in children.Methods From July 2017 to January 2022,32 children diagnosed with outflow tract obstruction post-LT are designated as HVOO group and examined by digital subtraction angiography(DSA).All of them underwent balloon dilation.Thirty cases with no vascular complications are selected as control group.Color Doppler blood flow parameters are recorded,including peak systolic velocity(PSV),peak diastolic velocity(PDV),PSV/PDV(S/D),resistive index(RI),portal vein velocity(PVV),hepatic vein velocity(HVV),hepatic vein waveform,anastomotic velocity and waveform.Intravascular pressure values of DSA within 48h are recorded.The correlations between color Doppler flow parameters and intravascular pressure values are examined before and after tube expansion.The differences of color Doppler flow parameters before tube expansion between HVOO and control groups are compared.And receiver operating characteristic(ROC)curves are plotted for obtaining ultrasonic parameters'cut-off value.Patients with excellent recovery are selected for comparing the difference of color Doppler blood flow parameters before and after tube expansion and detect the trend of hemodynamics.Results There is a positive correlation between anastomotic velocity of hepatic vein and inferior vena cava and DSA before and after tube expansion in HVOO group(r=0.483,0.414,all P<0.05);S/D,RI and anastomotic velocity are higher in HVOO group than those in control group(Z=-3.275,P=0.001;t=3.437,P=0.001;Z=-5.677,P<0.01);PV and HVV are lower in HVOO group than those in control group(Z=-2.719,P=0.007;Z=-6.762,P<0.01);The waveforms of hepatic vein and anastomosis in HVOO group are mostly single-phase waves,accounting for 81.25%(26/32)and 53.12%(17/32).Control group is mostly of dual-phase wave.According to ROC curve analysis,area under curve(AUC)of HVV diagnosing HVOO is 0.996 with a critical value of 21.65 cm/s;AU
作者
于慧敏
唐缨
武红涛
张国英
牛宁宁
Yu Huimin;Tang Ying;Wu Hongtao;Zhang Guoying;Niu Ningning(Deprtment of Ultrasound,Tianjin First Center Affiliated Hospital of Nankai University,Tianjin 300192,China)
出处
《中华器官移植杂志》
CAS
2023年第5期291-297,共7页
Chinese Journal of Organ Transplantation
基金
国家自然科学基金(82172031)
天津市卫健委科技人才培育项目(KJ20078)。
关键词
肝移植
儿童
肝静脉流出道梗阻
超声检查
Liver transplantation
Child
hapatic venous outflow obstruction
Ultrasonography
