Objective To investigate the application value of contrast enhanced ultrasound (CEUS) for postoperative monitoring after split liver transplantation. Methods Ten recipients undergoing split liver transplantation received conventional two-dimensional ultrasonography, color Doppler ultrasound (CDU) and CEUS. Clinical prognosis of 10 recipients undergoing split liver transplantation was summarized. The findings of postoperative conventional two-dimensional ultrasonography, CDU and CEUS were analyzed. Results Among 10 recipients, 8 cases obtained favorable clinical prognosis, one died from the recurrence and metastasis of malignant tumors and multiple organ failure, and one died from sudden cardiac arrest. CDU detected the hepatic artery in 8 of 10 recipients(80%). CEUS revealed hepatic artery embolism in one recipient and normal hepatic artery in the other case. Conventional two-dimensional ultrasonography demonstrated abnormality of the hepatic parenchyma in 5 recipients including hyperecho in S5 segment in 1 case, hypoecho in S7 segment in 1 case, hyperecho in S4 segment in 1 case, hypoecho followed by hyperecho in S5 and S6 segments in 1 case and multiple hypoecho and slight hyperecho in 1 case. CEUS revealed significant asynchrony in the microcirculation blood perfusion between the normal and abnormal echo regions, manifested with imaging features of early perfusion and early regression, which was considered to be associated with hepatic venous back-flow obstruction. Evident asynchrony in microcirculation blood perfusion between the normal and abnormal echo regions was observed in 1 case, manifested with the imaging features of early perfusion and synchronous regression,suggesting that congestion and edema on the hepatic resection surface caused by hepatic venous back-flow obstruction and myocardial infarction. Multiple intrahepatic abnormal blood perfusion region of 'fast-in and fast-out' echo was noted in 1 case, which was probably correlated with postoperative recurrence of malignant tumors. Conclusions CEUS is an effective supplement of conventional two-dimensional ultrasonography and CDU for postoperative monitoring after split liver transplantation, which contributes to understanding of hepatic blood flow and blood perfusion and identifying early postoperative complications after split liver transplantation.%目的 初步探讨超声造影在劈离式肝移植术后监测的应用价值.方法 对10例劈离式肝移植术后受者行常规二维超声、彩色多普勒超声(彩超)及超声造影检查.总结10例劈离式肝移植受者的预后情况;分析受者术后常规二维超声、彩超和超声造影的检测结果.结果 10例劈离式肝移植受者中,死亡2例,1例死于肿瘤复发多器官转移及多器官功能衰竭,1例死于心脏骤停,余8例预后良好.10例受者中,彩超检查肝动脉显示率为80%,未见显示的2例进一步行超声造影,结果提示肝动脉栓塞1例,肝动脉显示良好1例.10例中,常规二维超声肝实质回声显示异常5例,其中1例S5段呈高回声;1例S7段呈低回声;1例S4段呈高回声;1例S5及S6段先呈先低回声后高回声;1例肝内多发低回声及略高回声.超声造影显示3例回声异常区微循环血流灌注与正常回声区明显不同步,呈现早到达早消退的图像特征,考虑与肝静脉回流不畅有关;1例回声异常区其微循环血流灌注与正常区域明显不同步,呈现早到达同步消退的图像特征,考虑肝静脉回流不畅和心肌梗死导致肝脏断面处淤血及水肿;1例肝内多发"快进快出"异常灌注区,考虑术后肿瘤复发.结论 超声造影在劈离式肝移植术后监测中可作为常规二维超声及彩超的有效补充,有助于了解劈离式移植肝的血流及灌注情况,可及时发现肝移植术后早期并发症.
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