Liu Jinqiao,Chen Wenjuan,Yin Qiang,et al.Predictive value of hepatic artery resistance index for biliary anastomotic complications after liver transplantation in children[J].Journal of Clinical Pediatric Surgery,2020,19(11):1038-1041.[doi:10.3969/j.issn.1671-6353.2020.11.015]
肝动脉阻力指数对儿童肝移植术后胆道吻合口并发症的预测价值
- Title:
- Predictive value of hepatic artery resistance index for biliary anastomotic complications after liver transplantation in children
- Keywords:
- Ultrasound; Hepatic Artery; Resistance Index; Liver Transplantation; Biliary Complications; Child
- 分类号:
- R729;R445.1
- 摘要:
- 目的 评价肝动脉阻力指数对儿童肝移植术后胆道吻合口并发症的预测价值。方法 选择2015年12月至2020年7月在湖南省儿童医院接受肝移植的患儿共58例作为研究对象，收集彩色多普勒超声检测的肝动脉波形、阻力指数（hepatic artery resistance index，HARI）、加速时间（acceleration time，AT）、磁共振胆管成像等资料。将HARI进行分类分析，绘制肝动脉阻力指数的操作者工作特征（receiver operating characteristic，ROC）曲线，计算HARI预测胆道并发症发生的最佳临界点及其灵敏度、特异度、准确度。结果 58例接受肝移植患儿中发生胆道吻合口并发症16例；HARI预测胆道吻合口并发症的最佳临界点为0.58，其灵敏度、特异度、准确度分别为61.5%、89.3%、83%。HARI≤0.58的患儿发生胆道吻合口并发症的概率更高。结论 肝移植术后低阻力指数与胆道吻合口并发症相关，其HARI的最佳临界点为0.58，HARI≤0.58的患儿发生胆道吻合口并发症的概率更高。
- Abstract:
- Objective To assess the predictive value of hepatic artery resistance index (HARI) for biliary anastomotic complications after liver transplantation in children.Methods Retrospective reviews were conducted for 58 children undergoing liver transplantation at Hunan Children’s Hospital from December 2015 to July 2020.Hepatic artery waveform,HARI and acceleration time (AT) detected by color Doppler ultrasound and magnetic resonance cholangiopancreatography and general profiles were collected.The authors classified and analyzed HARI,plotted receiver operating characteristic (ROC) curve of HARI and calculated HARI for predicting the optimal critical point for biliary complications and evaluating its sensitivity,specificity and accuracy.Results Among them,16 had biliary anastomotic complications.The optimal cut-off point for HARI for predicting biliary anastomotic complications was 0.58 and its sensitivity,specificity and accuracy were 61.5%,89.3% and 83% respectively.Children with HARI ≤ 0.58 had a higher chance of developing biliary complications.Conclusion Low resistance index after liver transplantation is correlated with biliary anastomotic complications.And the optimal cut-off point of HARI is 0.58.Children with HARI ≤ 0.58 have a higher chance of developing biliary complications.
参考文献/References:
1 Diamond IR,Fecteau A,Millis JM,et al.Impact of graft type on outcome in pediatric liver transplantation:a report from Studies of Pediatric Liver Transplantation (SPLIT)[J].Ann Surg,2007,246(2):301-310.DOI:10.1097/SLA.0b013e3180caa415.
2 Heffron TG,Pillen T,Welch D,et al.Biliary complications after pediatric liver transplantation revisited[J].Transplant Proc,2003,35(4):1461-1462.DOI:10.1016/s0041-1345(03)00463-9.
3 Seehofer D,Eurich D,Veltzke-Schlieker W,et al.Biliary complications after liver transplantation:old problems and new challenges[J].Am J Transplant,2013,13(2):253-265.DOI:10.1111/ajt.12034.
4 Darius T,Rivera J,Fusaro F,et al.Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation[J].Liver Transpl,2014,20(8):893-903.DOI:10.1002/lt.23910.
5 Feier FH,Seda-Neto J,da Fonseca EA,et al.Analysis of factors associated with biliary complications in children after liver transplantation[J].Transplantation,2016,100(9):1944-1954.DOI:10.1097/TP.0000000000001298.
6 Takasaki S,Hano H.Three-dimensional observations of the human hepatic artery (arterial system in the liver)[J].J Hepatol,2001,34(3):455-466.DOI:10.1016/s0168-8278(00)00058-1.
7 Deltenre P,Valla DC.Ischemic cholangiopathy[J].Semin Liver Dis,2008,28(3):235-246.DOI:10.1055/s-0028-1085092.
8 Gunji H,Cho A,Tohma T,et al.The blood supply of the hilar bile duct and its relationship to the communicating arcade located between the right and left hepatic arteries[J].Am J Surg,2006,192(3):276-280.DOI:10.1016/j.amjsurg.2006.01.046.
9 Northover JM,Terblanche J.A new look at the arterial supply of the bile duct in man and its surgical implications[J].Br J Surg,1979,66(6):379-384.DOI:10.1002/bjs.1800660603.
10 Feier FH,Chapchap P,Pugliese R,et al.Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients[J].Liver Transpl,2014,20(8):882-892.DOI:10.1002/lt.23896.
11 Laurence JM,Sapisochin G,DeAngelis M,et al.Biliary complications in pediatric liver transplantation:Incidence and management over a decade[J].Liver Transpl,2015,21(8):1082-1090.DOI:10.1002/lt.24180.
12 Caiado AH,Blasbalg R,Marcelino AS,et al.Complications of liver transplantation:multimodality imaging approach[J].Radiographics,2007,27(5):1401-1417.
13 Feier FH,Seda-Neto J,da Fonseca EA,et al.Analysis of factors associated with biliary complications in children after liver transplantation[J].Transplantation,2016,100(9):1944-1954.DOI:10.1097/TP.0000000000001298.
14 Takasaki S,Hano H.Three-dimensional observations of the human hepatic artery (arterial system in the liver)[J].J Hepatol,2001,34(3):455-466.DOI:10.1016/s0168-8278(00)00058-1.
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备注/Memo
收稿日期:2020-09-08。
基金项目:湖南省发改委基金（编号：湘发改投资[2014]658号）
通讯作者:周启昌,Email:hnzqc2013@163.com