Appliation value of ultrasound in dynamic monitoring of bridging vessels in adult right half liver transplantation

doi:10.3877/cma.j.issn.1674-3903.2025.04.003

Abstract

Abstract:

Objective

To investigate the value of ultrasound in dynamic monitoring of bridging vessels in adult right half liver transplantation.

Methods

The data of adult right half liver transplantation recipients in the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from January 1, 2015 to June 30, 2024 were retrospectively analyzed. A total of 27 recipients were included and divided into bridging group (n=19) and non- bridging group (n=8) according to the mode of liver resection and middle hepatic vein (MHV) branch reconstruction. Perioperative data and liver function parameter 1 week after operation were collected. Ultrasound was used to dynamically monitor the blood flow of portal vein, bridging vessels, Ⅴ and Ⅷ segment veins during and after operation, and spectral shape was observed and blood flow parameters were measured. Measurement data were compared using independent sample t test or Mann-Whitney U test, and enumeration data were compared using chi-square test or Fisher′s exact probability test. P value <0.05 was considered statistically significant.

Results

There was no significant difference in sex, body mass index, model for end-stage liver disease score and albumin level, operation time, blood loss, anhepatic phase time and red blood cell transfusion, total postoperative hospital stay, portal vein flow on the 1st and 30th day after operation between the bridging group and the non-bridging group (P>0.05). The median postoperative ICU length of stay was 4.0 (3.0, 4.5) and 6.0 (5.5, 7.5) days in the bridging and non-bridging groups, respectively, and the difference was statistically significant (Z=-2.042, P<0.05). Within 1 week after operation, the liver function indicators of recipients in both groups steadily decreased, and the differences were not statistically significant (P>0.05). The flow velocities of the bridging vessels were (38.3±14.4), (30.7±13.4), (42.2±14.7), (38.7±14.4) and (36.0±21.4) cm/s during the operation and at 1, 7, 14, 30 days after transplantation, respectively, and the blood flow and spectrum showed well. Hepatic venous return was good in segments Ⅴ and Ⅷ of the transplanted liver, with venous flow velocities of (25.0±11.5) and (15.6±9.0) cm/s in segments Ⅴ on postoperative days 1 and 30, respectively; and (22.9±8.2) and (23.0±9.1) cm/s in segments Ⅷ on postoperative days 1 and 30, respectively.

Conclusions

Ultrasonography plays an important role in monitoring bridging vessels after MHV branch reconstruction in adult right half liver transplantation, and provides a sensitive and effective evaluation method for the detection of early postoperative vascular complications and liver allograft regeneration.

Key words: Adult right half liver transplantation, Middle hepatic vein, Bridging vessel, Ultrasonic examination

Xin Du, Lianghao Zhang, Zixuan Fu, Shuxian Wang, Jinquan Liu, Yuan Guo, Chuanshen Xu, Jinzhen Cai, Jianhong Wang. Appliation value of ultrasound in dynamic monitoring of bridging vessels in adult right half liver transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2025, 19(04): 226-231.

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References 24

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指标	非架桥组(n＝8)	架桥组(n＝19)	t/Z/χ²值	P值
术前资料
年龄(岁，±s)	47±8	42±14	0.948	>0.05
性别(例，男/女)	4/4	6/13	－	>0.05
BMI(kg/m²，±s)	21.5±1.4	22.1±2.9	－0.618	>0.05
MELD评分(分，±s)	17.0±8.5	17.3±8.4	－0.093	>0.05
白蛋白(g/L，±s)	36.0±6.3	36.4±7.9	－0.853	>0.05
腹水(例，无或少量/大量)	5/3	10/9	－	>0.05
供肝类型(例，活体/DBD)	6/2	9/10	－	>0.05
术中资料(±s)
手术时间(min)	674±127	710±133	－0.665	>0.05
冷缺血时间(min)	321±72	324±65	－0.073	>0.05
出血量(mL)	1 025±700	800±405	1.056	>0.05
无肝期时间(min)	58±13	54±10	0.857	>0.05
输注红细胞(U)	8.9±4.6	6.0±3.6	1.840	>0.05
术后资料
ICU住院时间[d，M(P₂₅，P₇₅)]	6.0(5.5，7.5)	4.0(3.0，4.5)	2.042	<0.05
总住院时间[d，M(P₂₅，P₇₅)]	35.5(28.5，43.5)	34.5(28.5，50.0)	0.195	>0.05
PVF(mL/min，±s)
术后第1天	839.9±207.1	950.8±400.5	－1.856	>0.05
术后第30天	691.8±110.5	760.7±200.5	－1.632	>0.05

指标	非架桥组(n＝8)	架桥组(n＝19)	t/Z/χ²值	P值
术前资料
年龄(岁，±s)	47±8	42±14	0.948	>0.05
性别(例，男/女)	4/4	6/13	－	>0.05
BMI(kg/m²，±s)	21.5±1.4	22.1±2.9	－0.618	>0.05
MELD评分(分，±s)	17.0±8.5	17.3±8.4	－0.093	>0.05
白蛋白(g/L，±s)	36.0±6.3	36.4±7.9	－0.853	>0.05
腹水(例，无或少量/大量)	5/3	10/9	－	>0.05
供肝类型(例，活体/DBD)	6/2	9/10	－	>0.05
术中资料(±s)
手术时间(min)	674±127	710±133	－0.665	>0.05
冷缺血时间(min)	321±72	324±65	－0.073	>0.05
出血量(mL)	1 025±700	800±405	1.056	>0.05
无肝期时间(min)	58±13	54±10	0.857	>0.05
输注红细胞(U)	8.9±4.6	6.0±3.6	1.840	>0.05
术后资料
ICU住院时间[d，M(P₂₅，P₇₅)]	6.0(5.5，7.5)	4.0(3.0，4.5)	2.042	<0.05
总住院时间[d，M(P₂₅，P₇₅)]	35.5(28.5，43.5)	34.5(28.5，50.0)	0.195	>0.05
PVF(mL/min，±s)
术后第1天	839.9±207.1	950.8±400.5	－1.856	>0.05
术后第30天	691.8±110.5	760.7±200.5	－1.632	>0.05

观察指标	术中	术后第1天	术后第7天	术后第14天	术后第30天
门静脉流速(cm/s)	53.1±24.7	50.2±22.7	48.5±20.7	43.2±17.8	40.5±15.5
门静脉流量(mL/min)	904.0±373.3	950.8±400.5	850.8±267.7	810.6±190.6	760.7±200.5
架桥血管流速(cm/s)	38.3±14.4	30.7±13.4	42.2±14.7	38.7±14.4	36±21.4
Ⅴ段肝静脉流速(cm/s)	22.3±13.5	25.0±11.5	21.8±9.5	18.9±10.5	15.6±9.0
Ⅷ段肝静脉流速(cm/s)	24.9±9.2	22.9±8.2	20.1±7.2	22.9±8.5	23.0±9.1

观察指标	术中	术后第1天	术后第7天	术后第14天	术后第30天
门静脉流速(cm/s)	53.1±24.7	50.2±22.7	48.5±20.7	43.2±17.8	40.5±15.5
门静脉流量(mL/min)	904.0±373.3	950.8±400.5	850.8±267.7	810.6±190.6	760.7±200.5
架桥血管流速(cm/s)	38.3±14.4	30.7±13.4	42.2±14.7	38.7±14.4	36±21.4
Ⅴ段肝静脉流速(cm/s)	22.3±13.5	25.0±11.5	21.8±9.5	18.9±10.5	15.6±9.0
Ⅷ段肝静脉流速(cm/s)	24.9±9.2	22.9±8.2	20.1±7.2	22.9±8.5	23.0±9.1

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