【摘要】 目的分析在不含肝中静脉的亲体右半肝移植中,不同内径肝中静脉属支重建流出道后移植肝的超声表现及血流动力学,为临床预防小肝综合征提供准确可靠的超声影像学依据。方法 2007年11月至2013年4月在昆明市第一人民医院肝移植研究中心进行亲体右半肝移植肝中静脉属支重建的患者共33例。15例受体肝中静脉重建属支内径3~5 mm,18例受体肝中静脉重建属支内径≥5 mm。超声检查观察移植肝大小形态、实质回声,术中及术后监测门静脉血流量。结果肝中静脉重建属支内径3~5 mm的15例受体术后均未发生小肝综合征;肝中静脉重建属支内径≥5 mm的18例受体中,3例术后发生小肝综合征,超声检查均表现为移植右半肝体积不同程度增大,右前叶Ⅴ、Ⅷ段淤血肿胀,实质回声减低不均匀,门静脉高压及门静脉血流量明显增加,最终导致肝功能不良而死亡。结论超声检查对活体肝移植术后移植肝的血流动力学,尤其是流出道及门静脉血流量的监测至关重要,可为术后早期并发症的检出提供更敏感、更有效的评估手段,为外科医师预防并及时干预小肝综合征提供可靠的影像学依据。更多还原

【Abstract】 Objective To analyze about ultrasonographic characteristics and hemodynamics in living donor liver transplantation without middle hepatic vein after hepatic vein reconstruction of different diameter of branches of middle hepatic vein, which could provide accurate and reliable ultrasound imaging basis for clinical prevention of small-for-size syndrome. Methods There were 33 patients in liver transplantation research center of the First People′s Hospital of Kunming who underwent the operation in living donor liver transplantation with different diameters of middle hepatic vein reconstructed in right liver lobe from November 2007 to April 2013. Totally 15 cases underwent reconstruction of middle hepatic vein with diameter of 3 to 5 mm. 18 cases underwent reconstruction of middle hepatic vein with diameter > 5 mm. Using ultrasound to observe the size form, echo of graft, and monitoring portal venous flow(PVF). Results No postoperative small-for-size syndrome was found in 15 cases with reconstruction of middle hepatic vein with diameter of 3 to 5 mm. While there were 3 cases with small-for-size syndrome in 18 cases with reconstruction of middle hepatic vein with diameter > 5 mm. The 3 recipients died of liver failure. Ultrasound showed the increased volume of right liver lobe after liver transplantation, the congestive and enlarged Ⅴ, Ⅷ segments of liver got, inhomogeneous decreased echo of liver, and portal hypertension and significantly increased PVF. Conclusions Ultrasound examination is very important for evaluating hemodynamics of liver after living donor liver transplantation, especially monitoring the outflow and PVF, which could provide more sensitive and effective information in the detection of early postoperative complications. Meanwhile ultrasound could provide reliable imaging basis for surgeons to prevent and treat small-for-size syndrome timely.更多还原