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Color Doppler ultrasound monitoring after orthotopic liver transplantation liver hemodynamics and clinical value

Author: ZhouYuanZuo
Tutor: HuangDaoZhong
School: Huazhong University of Science and Technology
Course: Medical Imaging and Nuclear Medicine
Keywords: Color Doppler ultrasound Orthotopic liver transplantation Complication Hepatic artery thrombosis Biliary complications Hepatic perfusion index
CLC: R657.3
Type: Master's thesis
Year: 2006
Downloads: 73
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Abstract


Objective: Two-dimensional and color Doppler ultrasound (CDUS) of orthotopic liver transplantation (OLT) after liver transplantation sonographic characteristics and hemodynamic changes, explore the postoperative characteristics and color Doppler ultrasound images Hepatic artery hemodynamic changes of normal; investigate hepatic artery complications after liver transplantation ultrasound diagnostic features such as hepatic arterial blood flow perfusion refers to the relationship between parameters and biliary complications. Methods: From May 2003, July 2005, right in our hospital in orthotopic liver transplantation in 75 patients without vascular and biliary complications in 30 patients within 30 days after surgery were systematically monitored application CDUS and analysis. And 7 cases of hepatic artery complications and 10 cases of patients with biliary complications ultrasound images were analyzed retrospectively. The patients were 64 males and 11 females, aged 22-55 years old, which is the primary disease with 31 cases of primary liver cancer, hepatitis B, cirrhosis, hepatic decompensation, 31 cases of severe hepatitis 7 cases, 3 cases of hepatitis C cirrhosis, alcoholic cirrhosis, 1 case, 1 case of liver metastasis of breast cancer, liver degeneration in one case. Ultrasound Contents: ① transplanted liver morphology, internal echo and extrahepatic bile duct; ② extrahepatic hepatic artery blood flow, arterial diameter, peak velocity (Ps), diastolic velocity (Ed), resistance index (RI), the average blood flow velocity (Vmean), calculate the graft hepatic artery blood flow per minute (HAF) and perfusion index (DPI); ③ portal vein diameter, time-averaged flow velocity (TAV), flow rate curve shape; ④ hepatic vein diameter, flow rate and inferior vena cava blood flow and so on. Results: 1. Above 30 cases of liver transplant patients with uncomplicated postoperative hemodynamic changes at different times as follows: liver transplantation within 7 days after hepatic artery blood flow velocity was significantly lower than the peak after 7 days, Ps = 57.07 ± 20.82cm / s, P = 0.04 (P lt; 0.05); resistance index in seven days was significantly higher than 7 days after, RI = 0.690 ± 0.09, P = 0.01 (P lt; 0.05); liver graft Inherent within 7 days of blood flow was significantly lower than 7 days, HAF = 152.1 ± 50.1ml/min, P = 0.04 (P lt; 0.05); liver transplantation portal vein blood flow velocity in the time-averaged significantly within seven days After more than seven days, TAV = 32.47 ± 14.35cm / s, P = 0.03 (P lt; 0.05); portal vein diameter after 7 days of less than 7 days after, D = 1.08 ± 0.16cm, P = 0.04 ( P lt; 0.05). Other flow parameters such as the diameter of the hepatic artery, portal blood flow, along with the extension of time after liver transplantation there was no significant difference (P gt; 0.05). 2.75 cases occurred in patients with hepatic artery complications after liver transplantation in seven patients (9%), of which 5 cases of hepatic artery thrombosis (7%), hepatic artery stenosis one case (1%), arteriovenous graft liver fistula in 1 case (1%). These seven cases of vascular complications in patients with six cases of surgically confirmed by angiography and ultrasound diagnosis, ultrasound diagnostic accuracy was 85.7%. 3.75 cases occurred in patients with biliary complications in 10 cases (13.3%), in which the bile duct transplantation anastomotic stenosis in 4 cases, 2 cases of bile duct stones, intrahepatic biliary sludge formation one case, transplantation biliary fistula in 3 cases. Biliary complications occurred after seven days from time to a more than a year. These cases were caused by ERCP, other imaging and confirmed by surgery. Conclusions: 1. Early after liver transplantation (1 week) hepatic artery flow velocity is low, the portal vein velocity high, this may be due to hepatic artery diameter smaller, early anastomotic patency edema due to blood flow, portal venous flow compensation resistance increased due to hepatic artery anastomosis with the edema disappeared, one week after the hepatic artery flow velocity into the normal range, the portal vein flow velocity is gradually returning to normal. (2) Color Doppler ultrasound can be more clearly show the two-dimensional structure, and liver transplantation hemodynamic status, its hepatic artery complications after liver transplantation has important diagnostic value, has become the first choice for patients after liver transplantation screening tool, monitor various complications. 3 due to hepatic arterial insufficiency after liver transplantation is one of the main causes of biliary complications. Color Doppler ultrasound can be used hepatic perfusion index (DPI) to evaluate the transplanted liver blood supply, and thus the detection of transplant biliary complications has important clinical value.

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CLC: > Medicine, health > Surgery > Of surgery > Abdominal surgery > Liver and liver tube
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