Section of Abdominal Imaging, HB6, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Radiographics. 2012 Jan-Feb;32(1):199-211. doi: 10.1148/rg.321115006.
Orthotopic liver transplantation (OLT) is the only definitive treatment for irreversible acute liver failure and chronic liver disease. In the immediate postoperative period after OLT, patients are closely monitored with Doppler ultrasonography (US) to detect treatable vascular complications and ensure graft survival. The first postoperative Doppler US examination is performed fairly early on the first postoperative day, before surgical wound closure has been performed. The immediate postoperative images, obtained when the effects of surgery are very recent, often reveal an array of findings that may appear alarming but that tend to normalize within a few days and are compatible with changes related to the surgery itself. These findings include a starry-sky appearance of reperfusion hepatic edema, transient foci of increased echogenicity, pneumobilia, small fluid collections, perihepatic hematomas, pleural effusion, temporary elevation of hepatic arterial velocity, transient elevation of resistive index (RI), decreased RI with tardus parvus waveform, increased portal venous flow and mono- or biphasic waveforms of the hepatic veins. Most of these changes revert to normal in the first postoperative week; deterioration atypical of transient changes requires further evaluation.
原位肝移植（OLT）是治疗不可逆性急性肝衰竭和慢性肝病的唯一有效方法。OLT 术后即刻，患者接受多普勒超声（US）密切监测，以发现可治疗的血管并发症并确保移植物存活。OLT 术后的首次多普勒 US 检查通常在术后第 1 天非常早的时候进行，此时尚未进行手术切口缝合。术后即刻的图像是在手术影响非常近期时获得的，通常会显示出一系列可能看起来令人担忧但在几天内趋于正常的发现，并且与手术本身相关的变化相兼容。这些发现包括再灌注肝水肿的星空外观、短暂的回声增强灶、气栓、小的液体积聚、肝周血肿、胸腔积液、肝动脉速度的暂时升高、阻力指数（RI）的短暂升高、延迟性小而缓慢波型的 RI 降低、门静脉血流增加以及肝静脉的单相或双相波型。这些变化中的大多数在术后第 1 周内恢复正常；与短暂变化不同的恶化需要进一步评估。
