The Significance Of Color Doppler Ultrasound In Diagnosing Early Hepatic Artery Complications After Liver Transplantation

Objective:Retrospective analysis of DCD in orthotopic liver transplantation in patients with postoperative application of color doppler ultrasound to monitor the results of the hepatic artery blood flow parameters,to explore the differences of hepatic artery blood flow parameters in patients with hepatic artery complications after operation and those without hepatic artery complications.At the same time,the ROC curve is used to define an ideal critical value,which can provide valuable reference for early postoperative detection of hepatic artery complications.Research Methods:Collect the clinical data of 62 adult DCD orthotopic liver transplantation in the first hospital of jilin university from June 2016 to December 2017.The data mainly includes the receptor age,gender,recipients,intraoperative datas(hot ischemia time,cold ischemia time,no liver period,operation time,intraoperative blood loss),the type of hepatic artery complications,postoperative color doppler ultrasound results: the hepatic artery peak systolic velocity(PSV),average flow velocity(Vmean),pulse index(PI),resistance index(RI).Instruments and methods :Using the(ALOKA)Prosound a7 color doppler ultrasound diagnostic instrument with a probe frequency of 3.5~5MHz.The first color doppler ultrasonography was performed within 24 hours after surgery,and was checked every day for 1 week after surgery.Routine examination of liver size,echo,pipeline structure and so on.The indicators included peak systolic velocity(PSV),mean velocity(Vmean),pulsation index(PI),and resistance index(RI).DSA was used to confirm the diagnosis of hepatic artery complications.According to the postoperative complications of hepatic artery,the62 cases were classified into non-arterial complication group and arterial complication group.Data using SPSS 25.0 software for data analysis,the measurement data of two groups,first through the Kolmogorov-Smirnov normality test,accord with normal distribution by using two independent sample t-test,does not conform to the sample with two independent Wilcoxon rank and inspection.Comparison between count data set using chi-square chi-square test,does not meet the chi-square spear inspection conditions with Fisher's exact probability.For the difference was statistically significant P<0.05.Application without arterial complications group in postoperative 1 week measured by color doppler ultrasound in minimum Peak Systolic Velocity and complications of the diagnosis of arterial complications of Peak Systolic Velocity,no arterial complications group 1 weeks maximum resistance index and postoperative complications of the diagnosis of arterial complications resistance index,drawing ROC curves,find out the best threshold,to predict possible hepatic artery complications after surgery.P<0.05 was considered statistically significant.Research Results:1.There was a statistically significant difference in PSV(70.85±30.32)of no arterial complication group and PSV(43.12 ± 15.65)of arterial complication group in one week after operation(P=0.000).2.There was no significant difference between the two groups of cold ischemia time,hot ischemic time,anhepatic phase,blood loss and operation time.The P values were(0.535,0.203,0.541,0.538,0.262).3.The ROC curves showed when postoperative PSV less than 30cm/s,the diagnosis of hepatic artery complications in sensitivity and specificity were 90% and 90.4%.When PSV ?30cm/s and RI>0.7,considering the type of arterial complications for splenic artery steal syndrome.Conclusions:The occurrence of arterial complications after liver transplantation is not related to cold ischemia time,hot ischemic time,anhepatic period,operation time and blood loss.The PSV of patients with postoperative hepatic artery complications was significantly lower than those of patients without hepatic artery complications.The PSV in the patients with no hepatic arterial complications was at a low point within 1 week after surgery,Within 1 weeks after operation,the PSV of the patients without hepatic artery complications was at a low level after 4~6days.Underwent color Doppler ultrasound revealed PSV less than 30cm/s,should pay attention to possible risk of hepatic artery complications,When PSV is less than 30cm/s and RI > 0.7,it should be considered that SASS may be present,which can appropriately increase the color doppler ultrasound frequency and detect hepatic artery complications and timely give corresponding treatment plan.