Intraoperative vessel Doppler evaluation of vessel coniplications of adult orthotopic liver trauspiantation / 中华器官移植杂志

ABSTRACT

Objective To analyze the role of the introperative vessel Doppler sonographic evaluation of the hepatic artery and portal vein. Methods Intraoperative vessel Doppler sonograms of 116 patients were analyzed for peak systolic velocity of hepatic artery and blood flow of the portal vein.In patients having abnormal findings on sonography (peak systolic velocity of hepatic artery less than 30 cm/s, blood flow of the portal vein less than 800 ml/s), the vascular anastomoses were checked.Results Fourteen of 116 cases revealed less hepatic arterial peak systolic velocity than 30 cm/s. In 9 of the 14 cases, the hepatic arterial peak systolic velocity was normal after injection of 0. 5 % lidocaine into celic trunk root, and papaverine and 654-2 into artery, 3 of the 9 cases endured artery thrombosis. In the other 5 of the 14 cases, by-pass anastomoses were done, and the hepatic arterial peak systolic velocity was normal, and no hepatic arterial complication occurred. Five of 116 cases revealed less hepatic portal vein blood flow than 800 ml/rnin. 4 of the 5 cases revealed shunt between portal vein and vena cava. The blood flow was normal after ligation of the shunt, and thrombosis occurred in 1 case of the 4. The another 1 of the 5 cases was presented with portal vein thrombosis of grade m, and the blood flow remained lower than normal when side-to-side anastomosis was done after resection of thrombosis. Then vein by-pass of the superior mesenteric vein to portal vein with donor iliac vein was done, the blood flow became normal, and no complication occurred. Conclusions The vessel Doppler sonography during liver transplantation was of pivotal values in preventing and diagnosing vessel complications. For the patients with abnormal findings though intraoperative vessel Doppler sonography, the close monitoring should be done in order to find out vessel complication as