Gu Lihong, Fang Hua, Zhang Shijun, Chi Jiachang, Li Fenghua, Xia Qiang
Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Interventional Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Pediatr Transplant. 2018 Aug;22(5):e13200. doi: 10.1111/petr.13200. Epub 2018 Apr 25.
Doppler ultrasonography is useful in monitoring intra-operative PV flow in LDLT. A retrospective cohort study included 550 pediatric recipients (<18 years) who underwent LDLT from October 2006 to August 2016 in our hospital. A total of 33 recipients (incidence 6%) were found to have insufficient intra-operative PV flow after PV reperfusion. The treatments included intra-operative stent placement (n=25), anticoagulation (n=3), thrombectomy and re-anastomosis (n=2), graft repositioning (n=1), collateral ligation (n=1), and replaced PV (n=1). The peak PV velocity, HAPSV, HARI, and HV velocity before and after the interventions were significantly improved 0(0,5.5) cm/s vs. 37.36±15.30 cm/s, 38.68±8.92 cm/s vs. 62.30±16.97 cm/s, 0.55±0.08 vs. 0.76±0.10, and 32.37±10.33 cm/s vs. 40.94±15.01 cm/s, respectively (P<.01). Insufficient PV flow and decreased HARI are two significant criteria indicating need for intra-operative PV management. Dramatic changes in the hepatic hemodynamics were detected after proper treatment. Immediate resolution of PV flow is feasible in pediatric LDLT.
多普勒超声检查在活体肝移植术中监测门静脉血流方面很有用。一项回顾性队列研究纳入了2006年10月至2016年8月在我院接受活体肝移植的550例儿科受者（<18岁）。共有33例受者（发生率6%）在门静脉再灌注后被发现术中门静脉血流不足。治疗方法包括术中放置支架（n=25）、抗凝（n=3）、血栓切除术及重新吻合（n=2）、移植物重新定位（n=1）、侧支结扎（n=1）和更换门静脉（n=1）。干预前后门静脉峰值流速、肝动脉峰值收缩期流速、肝动脉阻力指数和肝静脉流速显著改善，分别为0（0,5.5）cm/s对37.36±15.30 cm/s、38.68±8.92 cm/s对62.30±16.97 cm/s、0.55±0.08对0.76±0.10以及32.37±10.33 cm/s对40.94±15.01 cm/s（P<0.01）。门静脉血流不足和肝动脉阻力指数降低是表明术中需要进行门静脉管理的两个重要标准。经过适当治疗后检测到肝脏血流动力学发生了显著变化。在儿科活体肝移植中，立即解决门静脉血流问题是可行的。
