Sugimoto Hiroyuki, Kamei Hideya, Nakamura Taro, Fujii Tsutomu, Nomoto Shuji, Takeda Shin, Kiuchi Tetsuya, Nakao Akimasa
Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hepatogastroenterology. 2010 Jul-Aug;57(101):903-7.
BACKGROUND/AIMS: Hepatic venous congestion after living donor liver transplantation using right lobe graft produces various abnormalities on ultrasonography. Doppler sonography can reveal reversal of the portal flow direction in patients with acute and severe venous congestion and can show the presence of a functional intrahepatic anastomosis between the hepatic vein tributaries during the follow-up period in those people with improved congestion. However, few abnormal findings have so far been observed using gray-scale ultrasonography.
Thirteen patients who underwent living-donor liver transplantation using right lobe graft enrolled in this study. Postoperative ultrasonography was performed during the first 14 days after surgery. The serial changes of the congestive area indicated by gray-scale ultrasonography were quantitatively and qualitatively analyzed.
Gray-scale ultrasonography showed the congestive areas as hyperechoic lesion in comparison to normal hepatic parenchyma. Congestive areas were seen in 4 patients in the early postoperative period (1-3 postoperative days). The acoustic intensity was higher in the congestive areas than in non-congestive areas (19.7 +/- 1.6 vs. 9.7 +/- 1.8 dB, respectively) in the early postoperative period. However, there was no difference between the congestive and non-congestive areas (21.3 +/- 5.0 vs. 19.8 +/- 2.6 dB, respectively) in the late postoperative period (8-14 postoperative days). Interestingly, the acoustic intensity in the congestive area in the early postoperative period was similar to that in the non-congestive area in the late postoperative period (19.7 +/- 1.6 vs. 19.8 +/- 2.6 dB, respectively). In nine patients who had no congestive area, acoustic intensity was similar throughout the postoperative period.
Congestive areas can be seen in gray-scale ultrasonography. A congestive area may spread to a non-congestive area in patients whose congestive area can be seen on gray-scale ultrasonography in the early postoperative period.
背景/目的：活体供肝肝移植采用右叶供肝后，肝静脉淤血会在超声检查中产生各种异常表现。多普勒超声检查可发现急性和严重静脉淤血患者门静脉血流方向逆转，并且在淤血改善患者的随访期间，可显示肝静脉分支之间存在功能性肝内吻合。然而，迄今为止，灰阶超声检查很少发现异常表现。
本研究纳入了13例行右叶供肝活体肝移植的患者。术后第14天内进行了术后超声检查。对灰阶超声检查显示的淤血区域的连续变化进行了定量和定性分析。
与正常肝实质相比，灰阶超声检查显示淤血区域为高回声病变。术后早期（术后1 - 3天）有4例患者出现淤血区域。术后早期，淤血区域的回声强度高于非淤血区域（分别为19.7±1.6 dB和9.7±1.8 dB）。然而，术后晚期（术后8 - 14天），淤血区域与非淤血区域之间无差异（分别为21.3±5.0 dB和19.8±2.6 dB）。有趣的是，术后早期淤血区域的回声强度与术后晚期非淤血区域的回声强度相似（分别为19.7±1.6 dB和19.8±2.6 dB）。在9例无淤血区域的患者中，术后各阶段回声强度相似。
灰阶超声检查可发现淤血区域。术后早期灰阶超声检查可见淤血区域的患者，淤血区域可能会扩散至非淤血区域。
