超声造影在劈离式肝移植术后监测的应用价值初探

王建红; 赵扬; 李志强; 吴晓冬; 郭源; 臧运金

doi:10.3969/j.issn.1674-7445.2017.06.006

超声造影在劈离式肝移植术后监测的应用价值初探

doi: 10.3969/j.issn.1674-7445.2017.06.006

266003 青岛大学附属医院器官移植中心

基金项目:

青岛市市南区科技发展资金项目 2015-6-010-YY

详细信息

通讯作者:
臧运金, Email: zangyj3657@qq.com

中图分类号: R617, R445.1
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出版历程
- 收稿日期: 2017-08-28
- 网络出版日期: 2021-01-19
- 刊出日期: 2017-11-15

Application value of contrast enhanced ultrasound for postoperative monitoring after split liver transplantation

Organ Transplantation Center, the Affiliated Hospital of Qingdao University, Qingdao 266003, China

More Information

Corresponding author: Zang Yunjin, Email: zangyj3657@qq.com

摘要

摘要: 目的初步探讨超声造影在劈离式肝移植术后监测的应用价值。方法对10例劈离式肝移植术后受者行常规二维超声、彩色多普勒超声（彩超）及超声造影检查。总结10例劈离式肝移植受者的预后情况；分析受者术后常规二维超声、彩超和超声造影的检测结果。结果 10例劈离式肝移植受者中，死亡2例，1例死于肿瘤复发多器官转移及多器官功能衰竭，1例死于心脏骤停，余8例预后良好。10例受者中，彩超检查肝动脉显示率为80%，未见显示的2例进一步行超声造影，结果提示肝动脉栓塞1例，肝动脉显示良好1例。10例中，常规二维超声肝实质回声显示异常5例，其中1例S5段呈高回声；1例S7段呈低回声；1例S4段呈高回声；1例S5及S6段先呈先低回声后高回声；1例肝内多发低回声及略高回声。超声造影显示3例回声异常区微循环血流灌注与正常回声区明显不同步，呈现早到达早消退的图像特征，考虑与肝静脉回流不畅有关；1例回声异常区其微循环血流灌注与正常区域明显不同步，呈现早到达同步消退的图像特征，考虑肝静脉回流不畅和心肌梗死导致肝脏断面处淤血及水肿；1例肝内多发“快进快出”异常灌注区，考虑术后肿瘤复发。结论超声造影在劈离式肝移植术后监测中可作为常规二维超声及彩超的有效补充，有助于了解劈离式移植肝的血流及灌注情况，可及时发现肝移植术后早期并发症。
- 超声造影 /
- 肝移植，劈离式 /
- 彩色多普勒超声 /
- 微循环灌注 /
- 肝动脉栓塞 /
- 肝淤血 /
- 肿瘤复发
Abstract: Objective To investigate the application value of contrast enhanced ultrasound (CEUS) for postoperative monitoring after split liver transplantation. Methods Ten recipients undergoing split liver transplantation received conventional two-dimensional ultrasonography, color Doppler ultrasound (CDU) and CEUS. Clinical prognosis of 10 recipients undergoing split liver transplantation was summarized. The findings of postoperative conventional two-dimensional ultrasonography, CDU and CEUS were analyzed. Results Among 10 recipients, 8 cases obtained favorable clinical prognosis, one died from the recurrence and metastasis of malignant tumors and multiple organ failure, and one died from sudden cardiac arrest. CDU detected the hepatic artery in 8 of 10 recipients(80%). CEUS revealed hepatic artery embolism in one recipient and normal hepatic artery in the other case. Conventional two-dimensional ultrasonography demonstrated abnormality of the hepatic parenchyma in 5 recipients including hyperecho in S5 segment in 1 case, hypoecho in S7 segment in 1 case, hyperecho in S4 segment in 1 case, hypoecho followed by hyperecho in S5 and S6 segments in 1 case and multiple hypoecho and slight hyperecho in 1 case. CEUS revealed significant asynchrony in the microcirculation blood perfusion between the normal and abnormal echo regions, manifested with imaging features of early perfusion and early regression, which was considered to be associated with hepatic venous back-flow obstruction. Evident asynchrony in microcirculation blood perfusion between the normal and abnormal echo regions was observed in 1 case, manifested with the imaging features of early perfusion and synchronous regression, suggesting that congestion and edema on the hepatic resection surface caused by hepatic venous back-flow obstruction and myocardial infarction. Multiple intrahepatic abnormal blood perfusion region of 'fast-in and fast-out' echo was noted in 1 case, which was probably correlated with postoperative recurrence of malignant tumors. Conclusions CEUS isan effective supplement of conventional two-dimensional ultrasonography and CDU for postoperative monitoring after split liver transplantation, which contributes to understanding of hepatic blood flow and blood perfusion and identifying early postoperative complications after split liver transplantation.
- Contrast enhanced ultrasound /
- Liver transplantation, split /
- Color Doppler ultrasound /
- Microcirculation perfusion /
- Hepatic artery embolism /
- Hepatic congestion /
- Recurrence of malignant tumor

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图 1 1例劈离式肝移植术后肝动脉栓塞受者的彩超及超声造影图像

例6，女，51岁，因肝硬化失代偿期行劈离式肝移植术后2 d，彩超未见肝动脉显示（A图），超声造影门静脉显影，未见肝动脉显示（B图）

Figure 1. Doppler ultrasonography and contrast enhanced ultrasonography of a case with hepatic artery embolization after split liver transplantation

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图 2 1例劈离式肝移植术后受者的常规二维超声及超声造影图像

例7，男，42岁，因肝硬化行劈离式肝移植术后11 d，常规二维超声显示S5、S6段呈先低回声后高回声（A图），超声造影显示相应区域动脉早期高增强（B图）

Figure 2. Two dimentional ultrasonography and contrast enhanced ultrasonography of a case after split liver transplantation

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表 1 10例劈离式肝移植受者一般情况及超声检查结果

Table 1. General situation and ultrasound examination results of 10 recipients with split liver transplantation

例序	性别	年龄（岁）	术前诊断	手术方式	超声检查			预后
例序	性别	年龄（岁）	术前诊断	手术方式	常规二维超声	彩超	超声造影	预后
1	男	67	肝血管肉瘤	劈离式右半肝	肝内多发低回声及略高回声	肝动脉血流正常，移植肝桥静脉显示好	多发“快进快出”	肿瘤复发，死亡
2	女	66	肝硬化失代偿期	劈离式左半肝	回声均匀	肝动脉血流正常	造影剂灌注均匀	治愈
3	女	33	自身免疫性肝硬化	劈离式右半肝	S5段回声增高	肝动脉未显示	S5早到达早消退，3个月后到达一致	治愈
4	女	67	肝小静脉闭塞综合征	劈离式左半肝	回声均匀	肝动脉血流正常	造影剂灌注均匀	治愈
5	女	38	原发性肝细胞癌	劈离式右三叶	回声均匀	肝动脉血流正常	造影剂灌注均匀	治愈
6	女	51	肝硬化失代偿期	劈离式右半肝	S7段片状低回声	肝动脉未显示	肝动脉栓塞， S7段早到达早消退	治愈
7	男	42	肝硬化失代偿期	劈离式右半肝	S5、S6段呈先低回声后高回声	肝动脉低速低阻血流，移植肝桥静脉显示欠佳	S5、S6段早到达，后灌注均匀；移植肝桥静脉显示好	急性心肌梗死、心源性休克、胆瘘，治疗后恢复
8	女	60	肝硬化失代偿期	劈离式左半肝	回声均匀	肝动脉血流正常	造影剂灌注均匀	心脏骤停，死亡
9	女	42	肝硬化失代偿期	劈离式右三叶	回声均匀	肝动脉血流正常	造影剂灌注均匀	治愈
10	男	56	肝硬化失代偿期	劈离式右三叶	S4段回声增高	肝动脉血流正常	S4早到达早消退	治愈

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