课题背景：肝移植术后移植肝由于血流再灌注的损伤、排斥反应及血管吻合口的影响，可造成肝动脉、门静脉、肝静脉及胆管结构及血流动力学变化。当有并发症出现时，肝动脉、门静脉、肝静脉等血管壁的损害以及肝细胞水肿和汇管区炎性细胞浸润致肝脏肿胀等也可造成移植肝血流动力学变化。

应用要点：课题利用彩色多普勒超声结合静脉超声造影无创性、动态显示了病变微血管的形态和血流动力学变化，对于及时发现移植并发症，如肝动脉血流灌注不足、移植肝排斥反应及胆道并发症具有重要价值。这些造影信息在常规超声及一般彩色多普勒血流显像检查中无法获得，优于CT，MRI检查。

同行评价：文章总结了正常移植肝及其常见并发症如肝动脉栓塞、移植排斥反应及胆道并发症的彩色多普勒超声及超声造影声像图特征，对指导临床诊断及治疗具有重要的应用价值。

摘要
目的: 肝移植术后移植肝的血流动力学变化明显，检测其变化规律可及时发现移植术后并发症。利用彩色多普勒超声及超声造影检测移植肝血流动力学参数变化，用以评估移植肝脏功能，早期发现并发症。
方法：①选择1998-07/2006-12华中科技大学同济医学院附属同济医院收治的肝移植患者75例，另外选择同期于本院体检的健康人30例作为正常对照组。所有观察对象对实验均知情同意，且得到医院伦理道德委员会批准。②利用彩色多普勒超声检测不同时期肝动、静脉及门静脉峰值血流速度、时间平均血流速度、阻力指数、肝动脉血流灌注指数。11例肝移植患者进行了静脉超声造影检查，观察肝内病灶在动脉期、门脉期及实质期的超声增强变化。
结果：75例肝移植患者全部进入结果分析，无脱落。①肝移植术后28例无明显并发症患者术后15 d内门静脉时间平均血流速度增高，高于正常对照组（P < 0.05）；肝动脉峰值血流速度、血流量术后7 d内低于7 d之后（P < 0.05），阻力指数在7 d内高于7 d之后（P < 0.05）。②肝动脉血栓形成时，肝动脉峰值血流速度明显降低直至消失，门静脉时间平均血流速度明显增高呈锯齿波，肝动脉血流灌注指数明显降低。③肝移植排斥反应时，门静脉时间平均血流速度降低、肝动脉峰值血流速度降低、阻力指数升高、肝静脉三相波消失呈锯齿波等。④移植肝肝动脉血流灌注指数降低时，移植肝胆道并发症容易发生。⑤超声造影示7例患者移植肝术后出现肝癌复发病灶，其动脉期病灶回声增强，门脉期开始回声减低至实质期病灶呈低回声，2例肝动脉栓塞病例动脉期未显示肝动脉，门脉期及实质期显示肝内回声增强。
结论：彩色多普勒超声及超声造影检测的移植肝脏门静脉、肝动脉及肝静脉血流动力学参数变化可以用来评估正常及出现并发症的移植肝脏。
关键词：肝移植；超声检查，多普勒，彩色；血液动力学；并发症

黄道中，李开艳，张青萍，吴亮，刘景云.彩色多普勒超声及超声造影检测移植肝血流动力学变化及其并发症[J].中国组织工程研究与临床康复，2008，12(5):840-844 [www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-840(ps).pdf]

Hemodynamic changes and complications after liver transplantation detected by color Doppler ultrasonography and intravenous contrast-enhanced ultrasound

Abstract

AIM：Hemodynamic changes are obvious after liver transplantation. To detect its changes can find promptly post-transplantation complications. This study assessed hepatic function and early complications by examining hemodynamic changes by using color Doppler ultrasonography (CDUS) and intravenous contrast-enhanced ultrasound (CEUS).
METHODS: ①Totally 75 cases of orthotopic liver transplantation (OLT) were enrolled at the Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from July 1998 to December 2006. Another 30 healthy persons were enrolled at the same time as a normal control group. Informed consents were obtained from all the subjects. The experiments were approved by the Hospital's Ethics Committee. ②CDUS was used to measure peak systolic velocity (PS), resistance index (RI) and Doppler perfusion index (DPI) of the hepatic artery (HA), time average velocity (TAV) of portal vein (PV), as well as velocity of hepatic vein (HV) in three different stages after surgery. Eleven patients of them received CEUS to observe the changes in enhanced ultrasound in arterial phase, portal venous phase and parenchymal phase.
RESULTS: Totally 75 patients undergoing liver transplantation were included in the final results, no drop-out. ①For the 28 cases without obvious complication, TAV of PV increased and was significant higher than in normal control group 15 days after transplantation (P < 0.05), and its PS of HA decreased but RI increased and had a significant difference (P < 0.05) from the normal control group in 7 days after surgery. ②When the hepatic artery thrombosis (HAT), PS of HA obviously decreased, even defluxioed and its DPI also cut down, even defluxioed, but TAV of PV significantly increased as a high sawtooth wave. ③While the livers after transplantation were rejected, TAV of PV decreased, RI of HA increased and PS also cut down, and triphasic wave of HV were disappeared. ④When DPI of transplanted livers decreased, complications occurred in biliary tract of the transplanted livers. ⑤Seven cases of hepatic carcinoma relapse after OLT demonstrated hyperecho in the arterial phase and hypoecho in the portal and later phase on contrast-enhanced ultrasound. Two cases of HAT were not visualized enhancement in arterial phase of CEUS and enhance during the portal venous phase and parenchymal phase.
CONCLUSION: The hemodynamics changes in PV, HA and HV following liver transplantation are valuable for assessing the livers and its complication by CDUS and CEUS.

Huang DZ, Li KY, Zhang QP, Wu L, Liu JY.Hemodynamic changes and complications after liver transplantation detected by color Doppler ultrasonography and intravenous contrast-enhanced ultrasound.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(5):840-844(China) [www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-840(ps).pdf]