上海交通大学学报（医学版）

›› 2010, Vol. 30 ›› Issue (9): 1035-.doi: 10.3969/j.issn.1674-8115.2010.09.004

• 专题报道（影像医学与核医学） • 上一篇    下一篇

超声与增强CT联合评估小儿活体肝移植术前血管和血流状态的应用价值

张时君, 李凤华, 顾莉红, 方 华, 李 萍, 朱彩霞   

  1. 上海交通大学 医学院附属仁济医院超声医学科, 上海 200127
  • 出版日期:2010-09-25 发布日期:2010-09-27
  • 通讯作者: 李凤华, 电子信箱: proflifh@sina.com。
  • 作者简介:张时君（1980—）, 男, 硕士生；电子信箱: zsj8666@163.com。
  • 基金资助:

    上海市重点学科建设项目（S30203）

Ultrasound combined with enhancement CT in preoperative vascular evaluation for pediatric liver transplantation recipients

ZHANG Shi-jun, LI Feng-hua, GU Li-hong, FANG Hua, LI Ping, ZHU Cai-xia   

  1. Department of Ultrasound, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2010-09-25 Published:2010-09-27
  • Supported by:

    Shanghai Leading Academic Discipline Project, S30203

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摘要：

目的 探讨超声联合增强CT评价肝移植术前门静脉和肝动脉的临床应用价值。方法 对33例拟行小儿活体肝移植术的患儿术前行超声和增强CT检查，以术中探查及大体病理为金标准，比较超声和增强CT在诊断门静脉、肝动脉异常中的准确性。结果 33例患儿术中均证实门静脉和肝动脉通畅，超声和CT诊断门静脉通畅的准确性为100%和63.6%，差异有统计学意义（P<0.05）。超声及CT诊断肝动脉通畅的准确性均为100%。离肝组的氧分压和肝动脉流速均高于向肝组，其中离肝组中波动型流速曲线组又高于波浪型和城墙型，差异均有统计学意义（P<0.05）。对脐静脉重开超声诊断敏感性为76.9%，CT诊断敏感性为92.3%；CT还能发现其他肝周侧支循环。CT诊断肝动脉变异敏感性为83.3%，超声无法显示动脉变异。结论 超声可以对门静脉的血流方向和流速曲线作出准确评估，对门静脉的通畅性诊断价值优于CT。而增强CT对肝动脉的变异及门静脉侧支循环的检出更具优势，超声联合增强CT检查可以有很好的优势互补性，为小儿手术方案的制定提供了有效的影像学依据。

关键词: 小儿活体肝移植, CT, 超声

Abstract:

Objective To investigate the application of ultrasound and enhancement CT in evaluation of portal vein and hepatic artery anomalies in pediatric patients undergoing living donor liver transplantation. Methods Thirty-three pediatric patients selected for living donor liver transplantation underwent examinations of ultrasound and enhancement CT before operation, surgical findings and gross pathology were served as golden standard, and the accuracy of ultrasound and enhancement CT in evaluation of portal vein and hepatic artery anomalies was determined. Results Hepatic artery and portal vein were surgically confirmed patent in all these 33 patients. There were significant differences in the accuracy of diagnosis of portal vein patency between ultrasound and enhancement CT (100% vs 63.6%, P<0.05). The accuracy of diagnosis of hepatic artery by ultrasound and enhancement CT was 100% and 100%, respectively. The partial pressure of oxygen and mean flow velocity of hepatic artery in hepatofugal flow group were significantly higher than those in hepatopetal flow group (P<0.05), and the wave pattern of artery-type was significantly higher than that of wall-type and wave-type (P<0.05). The sensitivity of ultrasound in detection of patent umbilical vein was 76.9%, and that of CT was 92.3%. CT could detect the other collateral circulation around the liver. The sensitivity of CT in diagnosis of hepatic artery variations was 83.3%, while ultrasound could not detect the variations of arteries. Conclusion Ultrasound has a high value in evaluation of direction and wave pattern of portal vein flow, and has higher accuracy in detection of portal vein patency than CT. Enhancement CT performs better in detection of hepatic artery variation and patent umbilical vein, and ultrasound and enhancement CT may complement with each other in evaluation of vascular anomalies for pediatric patients undergoing living donor liver transplantation.

Key words: pediatric living donor liver transplantation, CT, ultrasound