| Objective : To evaluate the clinical significance and ultrasound diagnostic value of portal vein complications after liver transplantation by monitoring changes in portal vein hemodynamic parameters with color Doppler ultrasound technology.Methods: The clinical data of 99 patients who have undergone liver transplantation at the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from July 2015 to December 2018 were analyzed retrospectively.They were divided into portal vein complications(n=23)and non-portal vein complications(n=76)groups,according to whether portal vein complications have occurred within 2 years after surgery.In addition,30 healthy volunteers at the Affiliated Hospital of Qingdao University were selected as the control group at the same time.In the non-portal vein complications group,color Doppler ultrasound was used to observe the shape,echo and blood flow of the liver in patients 1,7,14,30,180,365 and 730 days after liver transplantation,and to record the maximum blood flow velocity of the portal vein and the blood flow of the portal vein.And compared with 30 health examiners.The portal vein hemodynamic changes were recorded in the portal vein complications group,and the ultrasonic image characteristics were analyzed retrospectively.Results:1.Compared with the normal control group,the maximum portal vein blood flow velocity and portal vein blood flow in the patients with non-portal complications were significantly higher than those in the normal control group on the 1st,7th,14 th,30th and 180 days after liver transplantation(all P<0.05).With the extension of time,the maximum portal venous flow velocity and portal venous blood flow in the non-portal complication group showed a decreasing trend.By 365 d after surgery,the differences between the maximum portal venous flow velocity and portal venous blood flow in the two groups were no longer statistically significant(P>0.05).2.Of the 23 patients in the portal vein complication group,9 had portal vein stenosis(PVS)and 14 had portal vein embolism(PVE).9 patients with PVS had a maximum portal flow velocity of 63.8(46.0,78.6)cm/s,which was higher than the nonportal complication group(35.0(29.6,41.8))cm/s 1 month after surgery,the difference was statistically significant(Z=-3.35,P<0.001).0.001).Portal blood flow was 993(887,1168)ml/min in 9 patients with PVS,which was higher than the non-portal complications group(811(682,1018))ml/min 1 month after surgery,the difference was statistically significant(Z=-2.37,P=0.020).The receiver operating characteristic curve(ROC)was drawn with the maximum blood flow velocity and blood flow of the portal vein as the test variables and whether PVS was diagnosed as the state variable.The results showed that the maximum blood flow velocity of portal vein and the optimal cutoff value of portal vein blood flow were 44.5 cm/s and 847 ml/min respectively,and the corresponding area under curve(AUC),sensitivity and specificity were 0.863,88.9%,81.6% and 0.592,66.7% and 57.9% respectively.In 14 cases of portal vein embolism,conventional ultrasound showed that the portal vein was filled with low echo or partially filled with low echo,and color Doppler showed that the blood flow signal was filled with defect or no blood flow.Conclusion:After liver transplantation,portal venous blood flow velocity,and blood flow are at high levels in the early postoperative period and can return to normal levels as time increases.Ultrasound dynamic monitoring of portal venous blood flow changes is of great clinical significance in the diagnosis of portal vein stenosis and portal vein embolism after liver transplantation. |
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