Lu Qiang, Wu Hong, Fan Yu-Ting, Luo Yan, Zhang Zhong-Wei
Department of Sonography, West China Hospital, Sichuan University, Chengdu 610041, China.
World J Gastroenterol. 2009 Jul 28;15(28):3550-4. doi: 10.3748/wjg.15.3550.
To evaluate the vessel grafts (VG) used to reconstruct the middle hepatic vein (MHV) tributaries with ultrasonography.
Twenty-four patients undergone living donor liver transplantation were enrolled in our study. MHV tributaries larger than 5 mm in diameter were reconstructed with interposition VG. Blood flow of the graft and interposition VG was checked by Doppler ultrasonography daily in the first 2 postoperative weeks and monthly followed up after discharge. The sensitivity of VG detected by ultrasonography was assessed using surgical records as references. Student's t test was used to compare the velocity of VG and occluded VG in chronic patents (> 3 mo).
Thirty-one VG were used to reconstruct the MHV tributaries. Ultrasonography identified 96.7% (30/31) of large MHV tributaries and 90.3% (28/31) of VG. The diameter of VG was 5.6 +/- 0.8 mm and the velocity of VG was 19.7 +/- 8.1 cm/s. Two VG (2/31, 6.5%) were occluded on the first postoperative day in one patient who suffered from persistent ascites and had a prolonged recovery of liver function. Twenty-six VG (26/31, 83.9%) were patent 2 wk after operation. Six (6/31, 19.4%) VG were patent over 3 mo after operation. Intrahepatic venous collaterals were detected in 29.2% (7/24) patients. The velocity of VG and occluded VG was 30.1 +/- 5.6 cm/s, 16.5 +/- 5.8 cm/s, respectively, in chronic patents. The difference between two groups was statistically significant (P < 0.001).
Our results indicate that most VG are patent in the first postoperative week while only a small portion with a higher velocity remains patent after 3 mo. Intrahepatic venous collaterals can be observed in some patients after occlusion of VG.
用超声评估用于重建肝中静脉（MHV）分支的血管移植物（VG）。
24例行活体肝移植的患者纳入本研究。直径大于5mm的MHV分支用间置VG重建。术后前2周每天用多普勒超声检查移植物和间置VG的血流，出院后每月随访。以手术记录为参考评估超声检测VG的敏感性。用Student's t检验比较慢性患者（>3个月）中VG和闭塞VG的血流速度。
31个VG用于重建MHV分支。超声识别出96.7%（30/31）的大MHV分支和90.3%（28/31）的VG。VG直径为5.6±0.8mm，VG血流速度为19.7±8.1cm/s。1例持续腹水且肝功能恢复延迟的患者术后第1天有2个VG（2/31，6.5%）闭塞。术后2周26个VG（26/31，83.9%）通畅。6个（6/31，19.4%）VG术后3个月以上仍通畅。29.2%（7/24）的患者检测到肝内静脉侧支。慢性患者中，VG和闭塞VG的血流速度分别为30.1±5.6cm/s、16.5±5.8cm/s。两组间差异有统计学意义（P<0.001）。
我们的结果表明，大多数VG在术后第一周通畅，而3个月后只有一小部分血流速度较高的仍保持通畅。VG闭塞后部分患者可观察到肝内静脉侧支。
