儿童肝移植术后门静脉狭窄的超声评估价值

何志忠; 周路遥

doi:10.3969/j.issn.1674-7445.2020.06.009

儿童肝移植术后门静脉狭窄的超声评估价值

doi: 10.3969/j.issn.1674-7445.2020.06.009

何志忠,
周路遥^,

523059 广东省东莞市人民医院超声科(何志忠);中山大学附属第一医院超声医学科(周路遥)

基金项目:

国家自然科学基金项目 81501480

广东省基础与应用基础研究基金项目 2019A1515010549

详细信息

作者简介:
何志忠，男，1986年生，学士，主治医师，研究方向为儿科超声诊疗，Email：riverhe03@163.com

通讯作者:
周路遥，男，1981年生，博士，副主任医师，研究方向为儿科超声诊疗，Email：zhouly6@mail.sysu.edu.cn

中图分类号: R617;R445.1
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出版历程
- 收稿日期: 2020-07-14
- 网络出版日期: 2021-01-19
- 刊出日期: 2021-01-19

Ultrasound evaluation value of portal vein stenosis after pediatric liver transplantation

He Zhizhong,
Zhou Luyao^,

Department of Ultrasound, Dongguan People's Hospital of Guangdong Province, Dongguan 523059, China

More Information

Corresponding author: Zhou Luyao, Email:zhouly6@mail.sysu.edu.cn

摘要

摘要: 目的探讨儿童肝移植术后门静脉狭窄（PVS）的超声特征及其诊断价值。方法回顾性分析肝移植术后门诊常规超声随访的84例儿童肝移植受者的临床资料。根据超声和数字减影血管造影术（DSA）检查结果将受者分为正常组（57例）和PVS组（27例）。采用超声监测门静脉是否狭窄，测量指标包括门静脉吻合口直径、吻合口流速、肝动脉流速、肝动脉阻力指数（RI）及脾脏长径等。比较PVS组和正常组受者的超声参数；分析超声参数在儿童肝移植术后PVS中的诊断价值。结果正常组门静脉吻合口直径大于PVS组[（0.44±0.08）cm比（0.27±0.10）cm]；正常组门静脉吻合口流速低于PVS组[（43±12）cm/s比（119±58）cm/s]，差异均有统计学意义（均为P < 0.001）。两组肝动脉流速、肝动脉RI及脾脏长径比较，差异均无统计学意义（均为P > 0.05）。儿童肝移植、公民逝世后器官捐献儿童肝移植及亲属活体器官捐献儿童肝移植中最佳诊断PVS的门静脉吻合口直径分别为0.35、0.35、0.33 cm，对应的曲线下面积（AUC）为0.906、0.916、0.906，灵敏度为0.947、0.951、0.938，特异度为0.852、0.833、0.889；最佳诊断PVS的门静脉吻合口流速分别为62.7、69.6、61.2 cm/s时，AUC为0.990、0.993、1.000，灵敏度为1.000、1.000、1.000，特异度为0.930、0.951、1.000。结论儿童肝移植术后PVS受者的超声检查表现为门静脉吻合口直径缩小、吻合口流速变快，具有较高的诊断价值。
- 肝移植 /
- 儿童肝移植 /
- 超声检查 /
- 门静脉狭窄 /
- 胆道闭锁 /
- 数字减影血管造影术 /
- 公民逝世后器官捐献 /
- 亲属活体器官捐献
Abstract: Objective To investigate the ultrasonographic features and its diagnostic value in portal vein stenosis (PVS) after pediatric liver transplantation. Methods Clinical data of 84 pediatric recipients undergoing liver transplantation who were followed up by routine ultrasound were retrospectively analyzed. According to ultrasound and digital subtraction angiography (DSA) results, all recipients were divided into the normal group (n=57) and PVS group (n=27). The incidence of PVS was assessed by ultrasound. The measurement parameters consisted of diameter of portal vein anastomosis, flow velocity of portal vein anastomosis, hepatic artery velocity, resistance index (RI) of hepatic artery and maximum diameter of the spleen, etc. The ultrasound parameters were statistically compared between the PVS and normal groups. The diagnostic value of ultrasound parameters for PVS after pediatric liver transplantation was evaluated. Results The diameter of portal vein anastomosis in the normal group was significantly larger than that in the PVS group[(0.44±0.08) cm vs. (0.27±0.10) cm], and the flow velocity of portal vein anastomosis in normal group was significantly lower than in the PVS group[(43±12) cm/s vs. (119±58) cm/s] (both P < 0.001). The hepatic artery velocity, RI of hepatic artery and maximum diameter of the spleen did not significantly differ between two groups (all P > 0.05). The diameter of portal vein anastomosis for the optimal diagnosis of PVS in pediatric liver transplantation, pediatric liver transplantation from organ donation after citizen's death and living-related donor pediatric liver transplantation was 0.35 cm, 0.35 cm and 0.33 cm, respectively. The corresponding area under curve (AUC) was 0.906, 0.916 and 0.906, the sensitivity was 0.947, 0.951 and 0.938, and the specificity was 0.852, 0.833 and 0.889, respectively. The flow velocity of portal vein anastomosis for the optimal diagnosis of PVS was 62.7 cm/s, 69.6 cm/s and 61.2 cm/s. The AUC was 0.990, 0.993 and 1.000, the sensitivity was 1.000, 1.000 and 1.000, and the specificity was 0.930, 0.951 and 1.000. Conclusions Ultrasound features of the pediatric recipients with PVS after liver transplantation include the smaller diameter of portal vein anastomosis and faster anastomotic flow velocity, which possess high diagnostic value.
- Liver transplantation /
- Pediatric liver transplantation /
- Ultrasound examination /
- Portal vein stenosis /
- Biliary atresia /
- Digital subtraction angiography /
- Organ donation after citizen's death /
- Living-related organ donation

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图 1 诊断儿童肝移植术后PVS的门静脉吻合口直径及流速的ROC曲线

注：A图为门静脉吻合口直径的ROC曲线；B图为门静脉吻合口流速的ROC曲线。

Figure 1. ROC curves of portal vein anastomotic diameter and flow velocity in the diagnosis of PVS after pediatric liver transplantation

下载: 全尺寸图片幻灯片

图 2 各组受者门静脉吻合口直径及流速的超声表现

注：A图示亲属活体器官捐献儿童肝移植术后正常组门静脉吻合口直径为0.56 cm；B图示亲属活体器官捐献儿童肝移植术后正常组门静脉吻合口峰值流速为36.9 cm/s；C图示亲属活体器官捐献儿童肝移植术后PVS组门静脉吻合口直径为0.22 cm；D图示亲属活体器官捐献儿童肝移植术后PVS组门静脉吻合口峰值流速为173.5 cm/s；E图示公民逝世后器官捐献儿童肝移植术后PVS组门静脉吻合口直径为0.26 cm；F图示公民逝世后器官捐献儿童肝移植术后PVS组门静脉吻合口峰值流速为210.3 cm/s。

Figure 2. Ultrasound images of portal vein anastomotic diameter and flow velocity of recipients in each group

下载: 全尺寸图片幻灯片

图 3 诊断公民逝世后器官捐献肝移植术后PVS的门静脉吻合口直径及流速的ROC曲线

注：A图为门静脉吻合口直径的ROC曲线；B图为门静脉吻合口流速的ROC曲线。

Figure 3. ROC curves of portal vein anastomotic diameter and flow velocity in the diagnosis of PVS after liver transplantation from organ donation after citizen's death

下载: 全尺寸图片幻灯片

图 4 诊断亲属活体器官捐献肝移植术后PVS的门静脉吻合口直径及流速的ROC曲线

注：A图为门静脉吻合口直径的ROC曲线；B图为门静脉吻合口流速的ROC曲线。

Figure 4. ROC curve of portal vein anastomotic diameter and flow velocity in the diagnosis of PVS after liver transplantation from living-related organ donation

下载: 全尺寸图片幻灯片

表 1 PVS组与正常组的超声参数比较

Table 1. Comparison of ultrasound parameters between PVS group and normal group (x±s)

组别	n	吻合口直径（cm）	吻合口流速（cm/s）	肝动脉流速（cm/s）	肝动脉RI	脾脏长径（cm）
正常组	57	0.44±0.08	43±12	59±17	0.73±0.06	7.5±2.0
PVS组	27	0.27±0.10	119±58	60±21	0.73±0.10	7.7±1.8
t或t'值		8.284	-6.740	-0.177	0.186	0.912
P值		＜0.001	＜0.001	0.860	0.853	0.423

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参考文献(25)

[1]	易述红, 杨扬, 陈规划.多学科合作, 努力达到儿童肝移植的最佳疗效[J].器官移植, 2020, 11(4):431-434. DOI: 10.3969/j.issn.1674-7445.2020.04.001. YI SH, YANG Y, CHEN GH. Multidisciplinary cooperation of achieving the optimal clinical efficacy of pediatric liver transplantation[J]. Organ Transplant, 2020, 11(4):431-434. DOI: 10.3969/j.issn.1674-7445.2020.04.001.
[2]	郭源, 臧运金.公民逝世后器官捐献供肝肝移植:我国儿童肝移植的新出路[J].器官移植, 2016, 7(2):85-88. DOI: 10.3969/j.issn.1674-7445.2016.02.001. GUO Y, ZANG YJ. Liver transplantation from donation after citizen's death: the new way of pediatric liver transplantation[J]. Organ Transplant, 2016, 7(2):85-88. DOI: 10.3969/j.issn.1674-7445.2016.02.001.
[3]	徐瑞芳, 何恩辉, 易展雄, 等.儿童肝移植术后门静脉狭窄诊断及预后的超声评估[J].中国医学装备, 2019, 16(9):39-42. DOI: 10.3969/J.ISSN.1672-8270.2019.09.011. XU RF, HE EH, YI ZX, et al. Sonographic assessment of diagnosis and prognosis for PVS post pediatric liver transplantation[J]. Chin Med Equipment, 2019, 16(9):39-42. DOI: 10.3969/J.ISSN.1672-8270.2019.09.011.
[4]	张致远, 金龙, 苏天昊, 等.儿童肝移植术后门静脉狭窄的血管腔内治疗进展[J].中国介入影像与治疗学, 2018, 15(8):506-508. DOI: 10.13929/j.1672-8475. 201803026. ZHANG ZY, JIN L, SU TH, et al. Diagnosis and treatment of portal vein stenosis after pediatric liver transplantation[J]. Chin J Interven Imaging Ther, 2018, 15(8):506-508. DOI: 10.13929/j.1672-8475.201803026.
[5]	陈喜萍, 唐毅.超声在小儿肝移植后血管并发症中的应用进展[J].中国医学影像技术, 2020, 36(2):299-302. DOI: 10.13929/j.issn.1003-3289.2020.02.032. CHEN XP, TANG Y. Application progresses of ultrasound in children vascular complications after liver transplantation[J]. Chin J Med Imaging Technol, 2020, 36(2):299-302. DOI: 10.13929/j.issn.1003-3289.2020.02.032.
[6]	ALFARES BA, BOKKERS RP. Successful percutaneous treatment of biliary stenosis after living donor liver transplantation in a child[J] Radiol Case Rep, 2019, 14(7):800-804. DOI: 10.1016/j.radcr.2019.03.039.
[7]	COURI T, HARMATH C, BAKER T, et al. Acute portal vein thrombosis after liver transplant presenting with subtle ultrasound abnormalities: a case report and literature review[J]. World J Hepatol, 2019, 11(2):234-241. DOI: 10.4254/wjh.v11.i2.234.
[8]	SARWAR A, CHEN C, KHWAJA K, et al. Primary stent placement for hepatic artery stenosis after liver transplantation: improving primary patency and reintervention rates[J]. Liver Transpl, 2018, 24(10):1377-1383. DOI: 10.1002/lt.25292.
[9]	KATANO T, SANADA Y, HIRATA Y, et al. Endovascular stent placement for venous complications following pediatric liver transplantation: outcomes and indications[J]. Pediatr Surg Int, 2019, 35(11):1185-1195. DOI: 10.1007/s00383-019-04551-9.
[10]	DEVCIC Z, TOSKICH BB, LIVINGSTON D, et al. Endovascular treatment of aortohepatic conduit stenosis following liver transplant[J]. Transplant Proc, 2020, 52(3):943-948. DOI: 10.1016/j.transproceed.2020.01.017.
[11]	YIN C, ZHU ZJ, WEI L, et al. Risk factors for portal vein stenosis in pediatric liver transplantation[J]. Clin Transplant, 2020, 34(8): e13992. DOI: 10.1111/ctr.13992.
[12]	杨宝玲, 高丽, 张福如, 等.儿童供肝成人肝移植术后并发症观察及护理[J].世界最新医学信息文摘, 2018, 18(97):208-209. DOI: 10.19613/j.cnki.1671-3141. 2018.97.154. YANG BL, GAO L, ZHANG FR, et al. Observation and nursing of complications after adult liver transplantation with pediatric donor liver[J]. World Latest Med InfDig, 2018, 18(97):208-209. DOI: 10.19613/j.cnki.1671-3141.2018.97.154.
[13]	于里涵, 汤睿, 李昂, 等.合并门静脉血栓患者肝移植术中血栓处理技巧[J/CD].中华肝脏外科手术学电子杂志, 2020, 9(2): 172-175. DOI: 10.3877/cma.j.issn.2095-3232.2020.02.017. YU LH, TANG R, LI A, et al. Intraoperative management of thrombosis in liver transplant patients complicated with portal vein thrombosis[J/CD]. Chin J Hepatic Surg(Electr Edit), 2020, 9(2): 172-175. DOI: 10.3877/cma.j.issn.2095-3232.2020.02.017.
[14]	KIM KS, KIM JM, LEE JS, et al. Stent insertion and balloon angioplasty for portal vein stenosis after liver transplantation: long-term follow-up results[J]. Diagn Interv Radiol, 2019, 25(3):231-237. DOI: 10.5152/dir.2019.18155.
[15]	王建红, 范宁, 郭源, 等.超声对原位劈离式肝移植术前供肝评估价值初探[J/CD].中华移植杂志(电子版), 2018, 12(1): 24-27. DOI: 10.3877/cma.j.issn.1674-3903. 2018.01.006. WANG JH, FAN N, GUO Y, et al. Clinical value preoperative evaluation of ultrasonography on liver grafts in in-suit split liver transplantation[J/CD]. Chin J Transplant(Electr Vers), 2018, 12(1): 24-27. DOI: 10.3877/cma.j.issn.1674-3903.2018.01.006.
[16]	郭瑞, 李晓航, 李峰, 等.肝移植术中入肝血流量对术后早期移植物功能不全的临床意义[J].中国医科大学学报, 2019, 48(3):240-244. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgykdxxb201903010 GUO R, LI XH, LI F, et al. Clinical significance of intraoperative blood flow into the transplanted liver in early allograft dysfunction after liver transplantation[J]. J Chin Med Univ, 2019, 48(3):240-244. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgykdxxb201903010
[17]	BYUN J, KIM KW, CHOI SH, et al. Indirect Doppler ultrasound abnormalities of significant portal vein stenosis after liver transplantation[J]. J Med Ultrason (2001), 2019, 46(1):89-98. DOI: 10.1007/s10396-018-0894-x.
[18]	SHAN QY, JIANG H, CHEN SL, et al. Postsurgical management of dilated biliary tract in children: ultrasound-guided percutaneous transhepatic cholangial drainage and subsequent percutaneous ultrasound cholangiography[J]. AJR Am J Roentgenol, 2020, 214(6):1377-1383. DOI: 10.2214/AJR.19.22225.
[19]	OGISO S, NAKAMURA M, TANAKA T, et al. Computational fluid dynamics-based blood flow assessment facilitates optimal management of portal vein stenosis after liver transplantation[J]. J Gastrointest Surg, 2020, 24(2):460-461. DOI: 10.1007/s11605-019-04279-w.
[20]	SUZUKI L, DE OLIVEIRA IR, WIDMAN A, et al. Real-time and Doppler US after pediatric segmental liver transplantation: Ⅱ. hepatic vein stenosis[J]. Pediatr Radiol, 2008, 38(4):409-414. DOI: 10.1007/s00247-007-0731-7.
[21]	CHONG WK, BELAND JC, WEEKS SM. Sonographic evaluation of venous obstruction in liver transplants[J]. AJR Am J Roentgenol, 2007, 188(6):W515-W521. DOI: 10.2214/AJR.06.1262.
[22]	MULLAN CP, SIEWERT B, KANE RA, et al. Can Doppler sonography discern between hemodynamically significant and insignificant portal vein stenosis after adult liver transplantation?[J]. AJR Am J Roentgenol, 2010, 195(6):1438-1443. DOI: 10.2214/AJR.10.4636.
[23]	PARK JH, YEO JH, KIM YS, et al. Portal vein stent for symptomatic malignant portal vein stenosis: a single-center experience[J]. Curr Probl Cancer, 2020, 44(2):100476. DOI: 10.1016/j.currproblcancer.2019.04.002.
[24]	MILLER CS, BARKUN AN, MARTEL M, et al. Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and Meta-analysis of randomized trials[J]. Endosc Int Open, 2019, 7(11):E1563-E1573. DOI: 10.1055/a-0998-8129.
[25]	NAIK KB, HAWKINS CM, GILL AE, et al. Clinical efficacy of percutaneous transhepatic portal vein angioplasty for late-onset portal vein stenosis in pediatric liver transplant patients[J]. Transplantation, 2018, 102(6):e282-e287. DOI: 10.1097/TP.0000000000002138.