肝移植术后胆管并发症的肝动脉彩色多普勒超声表现

doi:10.3877/cma.j.issn.2095-3232.2015.01.013

目的

利用彩色多普勒超声探讨肝动脉异常与肝移植术后胆管并发症发生的关系。

方法

回顾性研究2004年10月至2013年10月在中山大学附属第三医院接受诊治的98例肝移植患者临床资料。根据肝移植术后有否出现胆管并发症将患者分为胆管并发症组和无胆管并发症组。其中胆管并发症组52例，男49例，女3例；平均年龄（49±24）岁。无胆管并发症组46例，男41例，女5例；年龄（46±29）岁。所有患者均签署知情同意书，符合医学伦理学规定。肝移植术后90 d内采用彩色多普勒超声对移植肝进行检查，观察肝内外胆管和肝动脉血流参数。两组血流参数比较采用t检验。肝动脉异常发生率比较采用χ²检验。

结果

胆管并发症组肝动脉狭窄6例，肝动脉血栓3例，肝动脉狭窄合并肝动脉-门静脉瘘1例，肝动脉异常发生率为19%（10/52），明显高于无胆管并发症组的2%（1/46）（χ²=24.96，P<0.05）。胆管并发症组的肝固有动脉最大血流速度为（90±21）cm/s，明显大于无胆管并发症组的（67±17）cm/s，肝内动脉阻力指数为0.55±0.14，明显低于无胆管并发症组的0.64±0.08 （t=9.74，-16.96；P<0.05）。

结论

肝移植术后胆管并发症发生与肝动脉异常有关。彩色多普勒超声监测肝移植术后肝动脉血流动力学变化，有助于早期发现胆管并发症。

关键词: 肝移植, 手术后并发症, 超声检查，多普勒，彩色, 胆道疾病

Objective

To investigate the relation between hepatic arterial abnormity and biliary complications after liver transplantation with the use of color Doppler ultrasonography.

Methods

Clinical data of 98 patients undergoing liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from October 2004 to October 2013 were analyzed retrospectively. According to whether the patients suffered from biliary complications after liver transplantation, they were divided into biliary complication group and non-biliary complication group. There were 52 cases in biliary complication group [49 males,3 females, mean age:(49±24) years old]. There were 46 cases in non-biliary complication group [41 males, 5 females, mean age:(46±29) years old]. The informed consents of all patients were obtained and local ethical committee approval had been received. Color Doppler ultrasonography was performed to examine the liver graft 90 d after liver transplantation and the blood flow parameters of intra-, extrahepatic bile duct and hepatic artery were observed. The comparison of blood flow parameters between two groups was conducted using t test. The comparison of incidence of hepatic arterial abnormity was conducted using Chi-square test.

Results

In biliary complication group, hepatic artery stenosis was observed in 6 cases, hepatic artery thrombosis in 3 cases and hepatic artery stenosis combined with intrahepatic arteriovenous fistula in 1 case. The incidence of hepatic arterial abnormity was 19% (10/52), which was significantly higher than that in non-biliary complication group [2% (1/46)] (χ²=24.96, P<0.05). The maximum velocity of the proper hepatic artery in biliary complication group [(90±21) cm/s] was significantly higher than that in non-biliary complication group [(67±17)cm/s] and the resistance index of intrahepatic artery in biliary complication group (0.55±0.14) was significantly lower than that in non-biliary complication group (0.64±0.08) (t=9.74, -16.96; P<0.05).

Conclusions

Biliary complications after liver transplantation are associated with hepatic arterial abnormity. Monitoring the hemodynamic variation of hepatic artery after liver transplantation with color Doppler ultrasonography helps to diagnose the biliary complications early.

Key words: Liver transplantation, Postoperative complications, Ultrasonography, Doppler, color, Biliary tract diseases

图1 肝移植术后胆管并发症组与无胆管并发症组　患者彩色多普勒超声肝外动脉最大血流速度测量

图2 肝移植术后胆管并发症组与无胆管并发症组　患者彩色多普勒超声肝内动脉阻力指数测量

表1 肝移植受者术后胆管并发症与肝动脉血流参数的关系

分组	例数	肝动脉情况（例）		肝固有动脉最大血流速度（cm/s,±s）	肝内动脉阻力指数（±s）	肝内动脉加速度时间（s,±s）
分组	例数	异常	正常	肝固有动脉最大血流速度（cm/s,±s）	肝内动脉阻力指数（±s）	肝内动脉加速度时间（s,±s）
胆管并发症组	52	10	42	90±21	0.55±0.14	0.08±0.02
无胆管并发症组	46	1	45	67±17	0.64±0.08	0.07±0.01
统计值	?	χ²=24.96		t=9.74	t=-16.96	t=0.32
P值	?	<0.05		<0.05	<0.05	>0.05

表1 肝移植受者术后胆管并发症与肝动脉血流参数的关系

分组	例数	肝动脉情况（例）		肝固有动脉最大血流速度（cm/s,±s）	肝内动脉阻力指数（±s）	肝内动脉加速度时间（s,±s）
分组	例数	异常	正常	肝固有动脉最大血流速度（cm/s,±s）	肝内动脉阻力指数（±s）	肝内动脉加速度时间（s,±s）
胆管并发症组	52	10	42	90±21	0.55±0.14	0.08±0.02
无胆管并发症组	46	1	45	67±17	0.64±0.08	0.07±0.01
统计值	?	χ²=24.96		t=9.74	t=-16.96	t=0.32
P值	?	<0.05		<0.05	<0.05	>0.05

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Color Doppler ultrasound findings of hepatic artery in patients with biliary complications after liver transplantation

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Color Doppler ultrasound findings of hepatic artery in patients with biliary complications after liver transplantation