Li Wenfeng,Chen Wenjuan,Zhou Mengjie,et al.Application value of Doppler ultrasonography in the diagnosis of hepatic artery stenosis after liver transplantation in children[J].Journal of Clinical Pediatric Surgery,2023,22(05):454-459.[doi:10.3760/cma.j.cn101785-202209034-010]
多普勒超声在儿童肝移植术后肝动脉狭窄诊断中的应用研究
- Title:
- Application value of Doppler ultrasonography in the diagnosis of hepatic artery stenosis after liver transplantation in children
- Keywords:
- Liver Transplantation; Ultrasonography; Doppler; Hepatic Artery; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨儿童肝移植术后肝动脉狭窄(hepatic artery stenosis,HAS)的超声特征及其诊断价值。方法 回顾性分析2018年7月至2022年7月于湖南省儿童医院接受肝移植手术,并于本院超声科门诊随访的患儿临床资料。测量的肝动脉超声参数包括肝内动脉(intrahepatic artery,IHA)的收缩峰值速度(peak systolic velocity,PSV)、舒张末期速度(end-diastolic velocity,EDV)、阻力指数(resistance index,RI)、收缩期加速时间(systolic acceleration time,SAT)和肝外动脉(extrahepatic artery,EHA)的PSV。根据计算机断层扫描血管造影术(computed tomography angiography,CTA)检查结果,将患儿分为HAS组和无HAS组。比较多普勒超声与CTA诊断结果的一致性及两组的超声参数,分析超声参数在儿童肝移植术后HAS中的诊断价值。结果 共纳入68例肝移植术后患儿,其中HAS组12例,无HAS组56例。无HAS组的IHA RI高于HAS组[(0.68±0.65)比(0.43±0.95)],差异有统计学意义(P=0.007);无HAS组的IHA SAT低于HAS组[(0.03±0.01)s比(0.07±0.01)s],差异有统计学意义(P＜0.001);无HAS组的IHA PSV高于HAS组[(52.46±8.84)cm/s比(36.11±4.43)cm/s],差异有统计学意义(P＜0.001)。无HAS组的EHA PSV低于HAS组[(92.54±6.54)cm/s比(192.53±9.66)cm/s],差异有统计学意义(P＜0.001)。两组IHA EDV比较,差异均无统计学意义(P＞0.05)。对超声参数诊断HAS的价值进行量化分析,其中IHA PSV的曲线下面积(area under curve,AUC)为0.743(95%CI:0.583~0.886),灵敏度为0.539,特异度为0.793,对应的诊断界值为36.2 cm/s;IHA EDV的AUC为0.664(95%CI:0.498~0.831),灵敏度为0.642,特异度为0.969,对应的诊断界值为18.96 cm/s;IHA RI的AUC为0.914(95%CI:0.835~0.992),灵敏度为0.876,特异度为0.869,对应的诊断界值为0.57;IHA SAT的AUC为0.828(95%CI:0.689~0.958),灵敏度为0.822,特异度为0.914,对应的诊断界值为0.04 s;EHA PSV的AUC为0.668(95%CI:0.511~0.826),灵敏度为0.542,特异度为0.992,对应的诊断界值为194.7 cm/s;RI串联IHA STA的AUC为0.813(95%CI:0.660~0.965),灵敏度为0.642,特异度为0.985;RI并联IHA STA的AUC为0.899(95%CI:0.771~1.000),灵敏度为0.936,特异度为0.725。结论 多普勒超声在肝移植术后HAS诊断中具有一定价值,肝内动脉RI减低、SAT延长及两者联合有助于提高儿童肝移植术后HAS的诊断价值。
- Abstract:
- Objective To explore the ultrasonographic features and examine its diagnostic value in hepatic artery stenosis (HAS) after pediatric liver transplantation (LT).Methods Clinical data were retrospectively reviewed for 12 children undergoing LT from July 2018 to July 2022.Ultrasonic parameters of hepatic artery were detected,such as intrahepatic artery (IHA),peak systolic velocity (PSV),end-diastolic velocity (EDV),resistance index (RI),systolic acceleration time (SAT),extrahepatic artery (EHA) and peak systolic velocity (PSV).They were assigned into two groups of HAS and non-HAS according to the findings of computed tomography angiography (CTA).The relevant ultrasonic parameters were statistically compared between two groups.And the diagnostic values of ultrasound parameters for HAS after pediatric LT were evaluated.Results IHA RI was higher in normal group than that in HAS group[(0.68±0.65) vs.(0.43±0.95)](P=0.007).IHA SAT in normal group was lower than that in HAS group[(0.03±0.01) vs.(0.07±0.01) s](P<0.001).IHA PSV was higher in normal group than than in HAS group[(52.46±8.84)cm/s vs.(36.11±4.43)cm/s](P<0.001).EHA PSV was lower in normal group than that in HAS group[(92.54±6.54) vs.(192.53±9.66) cm/s](P<0.001).No significant inter-group difference existed between IHA EDV (P>0.05).The AUC of IHA PSV for diagnosing HAS was 0.743 (95%CI:0.583-0.886) with a sensitivity of 0.539 and a specificity of 0.793 and the corresponding diagnostic cutoff was 36.2 cm/s.The AUC of IHA EDV for diagnosing HAS was 0.664 (95%CI:0.498-0.831) with a sensitivity of 0.642 and a specificity of 0.969 and the corresponding diagnostic cutoff was 18.96 cm/s.The AUC of IHA RI for diagnosing HAS was 0.914 (95%CI:0.835-0.992) with a sensitivity of 0.876 and a specificity of 0.869 and the corresponding diagnostic cutoff was 0.57.The AUC of IHA SAT diagnosing HAS was 0.828 (95%CI:0.689-0.958) with a sensitivity of 0.822 and a specificity of 0.914 and the corresponding diagnostic cutoff was 0.04 s.The AUC of EHA PSV for diagnosing HAS was 0.668 (95%CI:0.511-0.826) with a sensitivity of 0.542 and a specificity of 0.992 and the corresponding diagnostic cutoff was 194.7 cm/s.The AUC of RI tandem STA for diagnosing HAS was 0.813 (95%CI:0.660-0.965) with a sensitivity of 0.642 and a specificity of 0.985.The AUC of RI and STA for diagnosing AS was 0.899 (95%CI:0.771-1.000) with a sensitivity of 0.936 and a specificity of 0.725.Conclusion Ultrasound has some value in the diagnosis of HAS after LT.A decrease of RI in IHA,a prolongation of SAT and the combination of the two help to diagnose the occurrence of HAS after LT in children.
参考文献/References:
[1] 吴龙龙,宋红丽.肝脏耐受性树突状细胞与肝移植免疫研究进展[J].中华肝胆外科杂志,2021,27(2):149-152.DOI:10.3760/cma.j.cn113884-20200317-00144. Wu LL,Song HL.Research advances of liver tolerogenic dendritic cells and liver transplantation immunity[J].Chin J Hepatobiliary Surg,2021,27(2):149-152.DOI:10.3760/cma.j.cn113884-20200317-00144.
[2] Rinaldi P,Inchingolo R,Giuliani M,et al.Hepatic artery stenosis in liver transplantation:imaging and interventional treatment[J].Eur J Radiol,2012,81(6):1110-1115.DOI:10.1016/j.ejrad.2011.02.055.
[3] Yoeli D,Ackah RL,Sigireddi RR,et al.Reoperative complications following pediatric liver transplantation[J].J Pediatr Surg,2018,53(11):2240-2244.DOI:10.1016/j.jpedsurg.2018.04.001.
[4] 刘金桥,陈文娟,尹强,等.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[J].临床小儿外科杂志,2020,19(11);1038-1041.DOI:10.3969/j.issn.1671-6353.2020.11.015. Liu JQ,Chen WJ,Yin Q,et al.Predictive value of hepatic artery resistance index for biliary anastomotic complications after liver transplantation in children[J].J Clin Ped Sur,2020,19(11):1038-1041.DOI:10.3969/j.issn.1671-6353.2020.11.015.
[5] Dodd GD 3rd,Memel DS,Zajko AB,et al.Hepatic artery stenosis and thrombosis in transplant recipients:Doppler diagnosis with resistive index and systolic acceleration time[J].Radiology,1994,192(3):657-661.DOI:10.1148/radiology.192.3.8058930.
[6] Astarc?oglu I,Egeli T,Gulcu A,et al.Vascular complications after liver transplantation[J].Exp Clin Transplant,2019,1-8.DOI:10.6002/ect.2018.0240.
[7] Patel P,DiNorcia J.The devil is in the detail:current management of perioperative surgical complications after liver transplantation[J].Curr Opin Organ Transplant,2019,24(2):138-147.DOI:10.1097/MOT.0000000000000616.
[8] Tang W,Qiu JG,Cai Y,et al.Increased surgical complications but improved overall survival with adult living donor compared to deceased donor liver transplantation:a systematic review and meta-analysis[J].Biomed Res Int,2020,2020:1320830.DOI:10.1155/2020/1320830.
[9] Sarwar A,Chen C,Khwaja K,et al.Primary stent placement for hepatic artery stenosis after liver transplantation:improving primary patency and reintervention rates[J].Liver Transpl,2018,24(10):1377-1383.DOI:10.1002/lt.25292.
[10] Abdelaziz O,Attia H.Doppler ultrasonography in living donor liver transplantation recipients:intra-and post-operative vascular complications[J].World J Gastroenterol,2016,22(27):6145-6172.DOI:10.3748/wjg.v22.i27.6145.
[11] Goh Y,Neo WT,Teo YM,et al.Role of contrast-enhanced ultrasound in the evaluation of post-liver transplant vasculature[J].Clin Radiol,2020,75(11):832-844.DOI:10.1016/j.crad.2020.05.003.
[12] Zheng BW,Tan YY,Fu BS,et al.Tardus parvus waveforms in Doppler ultrasonography for hepatic artery stenosis after liver transplantation:can a new cut-off value guide the next step?[J].Abdom Radiol (NY),2018,43(7):1634-1641.DOI:10.1007/s00261-017-1358-2.
[13] Brancatelli G,Katyal S,Federle MP,et al.Three-dimensional multislice helical computed tomography with the volume rendering technique in the detection of vascular complications after liver transplantation[J].Transplantation,2002,73(2):237-242.DOI:10.1097/00007890-200201270-00015.
[14] Kayahan Ulu EM,Coskun M,Ozbek O,et al.Accuracy of multidetector computed tomographic angiography for detecting hepatic artery complications after liver transplantation[J].Transplant Proc,2007,39(10):3239-3244.DOI:10.1016/j.transproceed.2007.08.097.
[15] Le TX,Hippe DS,McNeeley MF,et al.The sonographic stenosis index:a new specific quantitative measure of transplant hepatic arterial stenosis[J].J Ultrasound Med,2017,36(4):809-819.DOI:10.7863/ultra.16.01005.
[16] García Bernardo CM,Argüelles García B,Redondo Buil P,et al.Collateral development in thrombosis of the hepatic artery after transplantation[J].Transplant Proc,2016,48(9):3006-3009.DOI:10.1016/j.transproceed.2016.07.047.
相似文献/References:
[1]俞钢 朱小春 葛午平 林炎坤 金龙 劳伟华 史浩 肖尚杰 洪淳 周佳亮 傅晓静. 胎儿外科相关疾病的产前诊断及干预[J].临床小儿外科杂志,2011,10(02):111.
The antenatal diagnosis, tassessment, and therapy of fetal surgical anomalies[J].Journal of Clinical Pediatric Surgery,2011,10(05):111.
[2]刘金桥 何静波 陈文娟 陈叶 杨芳 尹海燕.高频超声及彩色多普勒对小儿睾丸肿瘤的诊断价值[J].临床小儿外科杂志,2011,10(02):130.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):130.
[3]李萌,于增文,李索林,等.超声多普勒血管显像在内结扎法腹腔镜脾切除术中的应用[J].临床小儿外科杂志,2008,7(03):4.
[4]解承兰,张兰,傅廷亮,等.胎儿腹部病变的产前诊断及围产期处理[J].临床小儿外科杂志,2007,6(02):5.
[5]杨振宇,陈福真,李滨,等.小儿亲体部分肝移植治疗肝母细胞瘤(附1例报告)[J].临床小儿外科杂志,2007,6(02):12.
[6]刘辉,林琼,傅忠,等.超声诊断先天性肥厚性幽门狭窄20例[J].临床小儿外科杂志,2007,6(02):20.
[7]罗远建,金科,甘青,等.儿童神经母细胞瘤的影像学表现[J].临床小儿外科杂志,2007,6(02):22.
[8]李长春 王珊 章均 欧阳军 孔祥如 杨超 赵珍珍 吕麟亚. B超引导下芯针穿刺活检术诊断儿童实体肿瘤的临床分析[J].临床小儿外科杂志,2011,10(04):247.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):247.
[9]周路遥 何秋明 朱莉玲 张遇乐 贺雪华 符柳江 夏慧敏. 术前超声评估可疑阑尾炎123例分析[J].临床小儿外科杂志,2011,10(04):270.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):270.
[10]陈文娟 段星星 李皓 张雪华 胡原 张号绒. 高频超声对疑似发育性髋关节异常患儿髋关节发育的评估价值[J].临床小儿外科杂志,2011,10(05):345.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):345.
[11]沈秋龙,陈亚军,彭春辉,等.肝脏硬度测量值预测胆道闭锁术后五年自体肝生存的价值研究[J].临床小儿外科杂志,2020,19(06):486.[doi:10.3969/j.issn.1671-6353.2020.06.005]
Shen Qiulong,Chen Yajun,Peng Chunhui,et al.Predicting five-year native liver survival after Kasai procedure of biliary atresia by liver stiffness measurement[J].Journal of Clinical Pediatric Surgery,2020,19(05):486.[doi:10.3969/j.issn.1671-6353.2020.06.005]
备注/Memo
收稿日期:2022-9-21。
基金项目:湖南省卫生健康委员会项目(202109021301)
通讯作者:刘金桥,Email:826423695@qq.com