Kim So Yeon, Kim Kyoung Won, Lee Seung Soo, Song Gi-Won, Hwang Shin, Kim Pyo Nyun, Lee Sung Gyu
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2 dong, Songpa-ku, Seoul 138-736, Korea.
AJR Am J Roentgenol. 2008 Apr;190(4):1010-7. doi: 10.2214/AJR.07.2825.
The objective of our study was to assess the value of Doppler sonography for the diagnosis of hepatic venous congestion in a modified right lobe graft during the early postoperative period after living donor liver transplantation.
Doppler sonography examinations were prospectively performed in 54 patients within 24 hours after living donor liver transplantation with a modified right lobe graft in which large (> 5 mm) middle hepatic vein (MHV) tributaries were reconstructed. The number, flow direction, and waveform of the MHV tributaries; the echogenicity of the surrounding parenchyma; and the flow direction of the corresponding portal branch were evaluated. Hepatic venous congestion was diagnosed when there was no color flow or a monophasic waveform of an MHV tributary. The sensitivity of Doppler sonography for the detection of MHV tributaries was assessed using donors' preoperative CT scans and surgical records as references. The diagnostic values of Doppler sonography for hepatic venous congestion were assessed using recipients' postoperative CT scans as references. Differences in prevalence of Doppler sonography findings between the group with hepatic venous congestion and the non-hepatic venous congestion group were assessed.
Doppler sonography enabled us to identify 90% (155/173) of all and 98% (129/131) of the large MHV tributaries. The sensitivity and specificity of Doppler sonography for hepatic venous congestion were 90% (28/31) and 77% (96/124), respectively, for all and 88% (15/17) and 85% (95/112), respectively, for large MHV tributaries. Parenchymal hyperechogenicity was more commonly seen in the hepatic venous congestion group (65%, 20/31) than in non-hepatic venous congestion group (6%, 7/124) (p < 0.01). All five MHV tributaries with reversed flow were seen in the non-hepatic venous congestion group. All five portal branches with hepatofugal flow were seen in the hepatic venous congestion group.
Doppler sonography provides a reliable noninvasive surveillance tool for hepatic venous congestion in a modified right lobe graft during the early postoperative period after living donor liver transplantation.
本研究的目的是评估多普勒超声检查在活体肝移植术后早期对改良右叶移植肝肝静脉淤血的诊断价值。
对54例行改良右叶移植肝活体肝移植术后24小时内的患者进行前瞻性多普勒超声检查，改良右叶移植肝重建了粗大（>5mm）的肝中静脉（MHV）分支。评估MHV分支的数量、血流方向和波形；周围实质的回声；以及相应门静脉分支的血流方向。当MHV分支无彩色血流或呈单相波形时，诊断为肝静脉淤血。以供体术前CT扫描和手术记录为参考，评估多普勒超声检测MHV分支的敏感性。以受体术后CT扫描为参考，评估多普勒超声对肝静脉淤血的诊断价值。评估肝静脉淤血组和非肝静脉淤血组多普勒超声检查结果发生率的差异。
多普勒超声能够识别所有MHV分支的90%（155/173）和粗大MHV分支的98%（129/131）。多普勒超声对肝静脉淤血的敏感性和特异性，所有MHV分支分别为90%（28/31）和77%（96/124），粗大MHV分支分别为88%（15/17）和85%（95/112）。肝实质高回声在肝静脉淤血组（65%，20/31）比非肝静脉淤血组（6%，7/124）更常见（p<0.01）。所有5支血流反向的MHV分支均见于非肝静脉淤血组。所有5支血流离肝的门静脉分支均见于肝静脉淤血组。
多普勒超声为活体肝移植术后早期改良右叶移植肝肝静脉淤血提供了一种可靠的无创监测工具。
