儿童肝移植术后门静脉狭窄的超声评估价值

Ultrasound evaluation value of portal vein stenosis after pediatric liver transplantation

    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。

     

    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.

     

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