Color Doppler Ultrasound In Donors Of Cardiac Death Research Of The Liver Transplantation

Objective:By two-dimensional ultrasound observe the morphology, size, blood vessels, liver bile duct of liver inside and outside, within the liver and liver have weeks without abnormal echo of the liver and livertransplantation. Application of color doppler technology to observe the hepatic artery, portal vein and hepatic vein, inferior vena cava blood flow and doppler spectrum morphology and blood flow parameter measurement. Then make a comprehensive analysis, reflect the DCD for liver and graft morphological structure and hemodynamic information. Research on ultrasonic imaging techniques to evaluate the quality of the DCD for liver effective indicators. Ultrasonology evaluation quality and DCD liver transplantation liver function status and prognosis of relevance, comprehensive evaluation for clinicians DCD for liver, provide timely and reliable imaging basis of DCD condition and prognosis judgement of liver grafts function provides guidance significance, help clinicians deal with all kinds of complications, early diagnosis to improve DCD graft survival.Methods:Cases collected:in June 2012 to December 2015 to the hospital for a liver transplant in 57 cases of DCD for liver and liver transplantation.Routine ultrasound examination for the first time within 24 h after surgery, postoperative every 24 h once within 1 week,2 weeks instead of 2 d once, then 1-2 times a week,3 months after 1 to 2 months time, in the abnormal situation appropriate increase or decrease frequency of inspection. The patient supine position, in the upper right abdomen of DCD graft section scan, measurement of the right liver lobe oblique diameter, left liver thick thickness to diameter, observe the liver morphology, internal echo, bile duct anastomosis, within the liver and liver have weeks without exception, the chest and abdominal cavity effusion. Observation vascular anastomosis and the hepatic artery, portal vein and hepatic vein and inferior vena cava in presence of abnormal echo, filled with blood flow and spectrum morphology and blood flow parameter measurement. After obtaining spectrum curve of the three, frozen image measuring hepatic artery systolic peak velocity (Vmax), end-diastolic velocity (Vmin), acceleration (Acce), acceleration time (AT), resistance index (RI), portal vein and hepatic vein and inferior vena cava diameter and flow velocity..Results:Successful collection 57 cases of liver transplantation DCD graft receptors in June 2012 to December 2015 in the first hospital of Kunming.53 cases of orthotopic liver transplantation, kidney transplantation in 1 case, the consolidation of the left hepatic lobe resection after orthotopic liver transplantation (volume reduction) in 3 cases.included 44 male patients and 13 female patients, the ages of the patients varied from 4 to 72 years, an average of 46 years old, Postoperative improvement in 44 cases,13 cases of death.13 cases of victim died 2 weeks after surgery. Ultrasonic features:2D gray-scale sonography:in DCD early after livertransplantation, liver transplantation can increase slightly, some patients the liver parenchyma echo can have a higher sex and medium can be back to normal. Performance of bile duct of liver inside and outside more than normal, a few light to moderate expansion, bile duct wall echo can be enhanced, mid-much to return to normal; After liver transplantation and its secondary normal hepatic veins in two-dimensional ultrasound can display. After liver transplantation of liver, peritoneal and pleural effusion is a small amount of effusion or limitations; Long-term the liver size, essence normally; Performance of bile duct of liver inside and outside more than normal, There is no special performance of liver blood vessels.Color doppler ultrasound:hepatic artery usually need beats liver with color doppler blood flow signal to prompt its existence, spectrum morphology and normal liver, early (2 weeks) hepatic arteries speed can be slow than normal, the resistance index increased, medium-term recoverable. Portal vein color doppler (2 weeks) can show early bidirectional blood red and blue, a continuous burr shape spectrum, with breathing exercises had mild ups and downs, average flow velocity is higher than normal, medium-term (2 weeks-1 month) recoverable for into the hepatic blood flow in one direction and velocity gradually returned to normal or slightly higher. Hepatic vein near heart is red and blue blood flow signals more, about 20% of the patients can also be a monochrome from hepatic blood flow signals, for three-phase or duplex wave spectrum form, a few a one-way spectrum, early (2 weeks) flow rate higher than normal, medium-term (2 weeks)-1 month back to three-phase or duplex wave, velocity gradually returned to normal range. Inferior vena cava for single color blood flow signal, close to the heart can be characterized by three phase or similar to the hepatic vein duplex wave, amplitude decreased and gradually become a continuous telecentric end; Forward (January) after hepatic artery, portal vein and hepatic vein, inferior vena cava blood flow more than normal.This study of 57 cases of DCD graft, hepatic artery and portal vein blood flow closely monitoring the blood flow parameters measured value is volatile. Recent (1-2 weeks) maximum flow rate from the hepatic artery between 90.27±33.20 to 59.96 ±18.27cm/s, maximum flow rate between33.68± 19.55 to 17.45±9.49 cm/s, RI between 0.72±0.08 to 0.63±0.10, AT between 108.5±36.18 to 54.6±14.49ms, Acce between 1091.2±490.00 to 443.83±330.84 cm/s2, Portal vein V between 67.90±20.97 to 52.31±11.38 cm/s. Medium-term (2 weeks-1 month):Vmax between 81.99±19.38 to 77.66±47.48 cm/s, Vmin between 33.68±19.55 to 25.43 ±25.45 cm/s, RI between 0.71±0.09 to 0.63±0.11, AT between 95.25±36.49 to 70.37±31.91ms, Acce between 668.91±304.54 to 591.17±367.95 cm/s2, Portal vein V between 67.90±20.97 to 66.98±17.53 cm/s. The forward (after a month), Vmax between 88.22±21.23 to 74.18±22.12cm/s, Vmin between 36.16±17.43 to 16.48±10.83cm/s、RI between 0.77±0.10 to 0.65±0.08, AT between 110.21± 44.46 to 70.13±24.36ms, Acce between 841.13±414.23 to 640.74±329.16 cm/s2, Portal vein V between 53.95±22.00 to 41.75±14.40cm/s. The blood flow parameters measured value is volatile, within a week to stabilize after a week.Complications:57 cases were found in the hepatic artery stenosis in 2 cases (3.5%), hepatic artery pseudoaneurysms in 1 case (1.2%), portal vein thrombosis in 2 cases (3.5%), inferior vena cava thrombosis in 1 case (1.2%), inferior vena cava stenosis in 2 cases (3.5%), bile duct stenosis in 3 patients (5.2%), gallstones or bile mud formation in 2 cases (3.5%), bile leakage in 1 case (1.2%), biliary tumor 1 case (1.2%),8 cases of acute rejection (14%), pleural effusion,57 cases (100%), abdominal cavity effusion of 57 cases (100%), intrahepatic and peripheral hepatic hematoma 31 cases (54.3%).This study of 57 cases of DCD graft conventional ultrasonic monitoring,5 cases in the diagnosis of suspected, by angiography confirmed finally,10 cases showed is difficult, imaging showed clearly.Conclusion:By color doppler flow imaging (cdfi) in DCD monitoring for the evaluation of liver and liver transplantation research, understand the quality and DCD for liver transplantation liver function status and prognosis of relevance, comprehensive evaluation for clinicians DCD for liver, provide timely and reliable imaging basis of DCD condition and prognosis judgement of liver grafts function provides guidance significance. Help clinicians deal with all kinds of complications, early diagnosis to improve DCD graft survival.