活体肝移植术中两种门静脉血流测量装置的比较：通过渡越时间超声和传统多普勒超声测量

Comparison of Two Devices for Intraoperative Portal Venous Flow Measurement in Living-Donor Liver Transplantation: Transit Time Ultrasound and Conventional Doppler Ultrasound.

作者信息

Wang H-K, Chen C-Y, Lin N-C, Liu C-S, Loong C-C, Lin Y-H, Lai Y-C, Chiou H-J

机构信息

Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.

School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.

出版信息

Transplant Proc. 2018 May;50(4):1157-1159. doi: 10.1016/j.transproceed.2018.01.037.

DOI:10.1016/j.transproceed.2018.01.037

PMID:29731085

Abstract

BACKGROUND

Intraoperative portal venous flow measurement provides surgeons with instant guidance for portal flow modulation during living-donor liver transplantation (LDLT). In this study, we compared the agreement of portal flow measurement obtained by 2 devices: transit time ultrasound (TTU) and conventional Doppler ultrasound (CDU).

METHODS

Fifty-four recipients of LDLT underwent intraoperative measurement of portal flow after completion of vascular anastomosis of the implanted partial liver graft. Both TTU and CDU were used concurrently. Agreement of TTU and CDU was assessed by intraclass correlation coefficient using a model of 2-way random effects, absolute agreement, and single measurement. A Bland-Altman plot was applied to assess the variability between the 2 devices.

RESULTS

The mean, median, and range of portal venous flow was 1456, 1418, and 117 to 2776 mL/min according to TTU; and 1564, 1566, and 119 to 3216 mL/min according to CDU. The intraclass correlation coefficient of portal venous flow between TTU and CDU was 0.68 (95% confidence interval, 0.51-0.80). The Bland-Altman plots revealed an average variation of 4.8% between TTU and CDU but with a rather wide 95% confidence interval of variation ranging from -57.7% to 67.4%.

CONCLUSIONS

Intraoperative TTU and CDU showed moderate agreement in portal flow measurement. However, a relatively wide range of variation exists between TTU and CDU, indicating that data obtained from the 2 devices may not be interchangeable.

摘要

背景

术中门静脉血流测量为活体肝移植（LDLT）手术期间门静脉血流调节提供即时指导。在本研究中，我们比较了两种设备所测门静脉血流的一致性：渡越时间超声（TTU）和传统多普勒超声（CDU）。

方法

54例LDLT受者在植入部分肝移植物的血管吻合完成后接受术中门静脉血流测量。同时使用TTU和CDU。采用双向随机效应、绝对一致性和单次测量模型，通过组内相关系数评估TTU和CDU的一致性。应用Bland-Altman图评估两种设备之间的变异性。

结果

根据TTU测量，门静脉血流的均值、中位数和范围分别为1456 mL/min、1418 mL/min和117至2776 mL/min；根据CDU测量，分别为1564 mL/min、1566 mL/min和119至3216 mL/min。TTU和CDU之间门静脉血流的组内相关系数为0.68（95%置信区间，0.51 - 0.80）。Bland-Altman图显示TTU和CDU之间的平均差异为4.8%，但95%置信区间差异范围较宽，为-57.7%至67.4%。