肝移植缺血性胆道病变的超声造影研究  

Application of contrast - enhanced ultrasound in the diagnosis of ischemic - type biliary lesion after liver transplantation

作　　者：任杰[1] 郑荣琴[1] 吕明德[2] 毛永江[1] 廖梅[1] 吕艳[1] 

机构地区：[1]中山大学附属第三医院超声科,广州510630 [2]中山大学附属第一医院肝胆外科

出　　处：《中华超声影像学杂志》2008年第7期587-589,共3页Chinese Journal of Ultrasonography

基　　金：广州市科委科研基金资助（2004Z-E0371）

摘　　要：目的探讨实时超声造影技术诊断肝移植术后缺血性胆道病变（ITBL）的临床应用价值。方法25例经内镜下逆行性胰胆管造影或经皮肝穿刺胆道造影确诊，超声疑为胆道并发症的移植肝接受超声造影检查。以增厚最明显的肝门部胆管壁为观察目标，分析胆管壁增强特点。结果胆管壁造影表现可分3类：①胆管壁无增强者6例，即胆管壁在动脉期、门脉期及延迟期均无增强；②胆管壁低增强水平者4例，即胆管壁在动脉期呈低增强，门脉期及延迟期持续低增强或消退为无增强；③胆管壁高增强水平者15例，即胆管壁在动脉期呈高或等增强，门脉期及延迟期消退为等或低增强。25例确诊病例中包括13例ITBL和12例非ITBL。ITBL组胆管壁无或低增强水平者10例（76．9％），高增强水平者3例（23．1％）；非ITBL组均为高增强水平者，两组间差异有统计学意义（P=0．00）。结论超声造影检测胆管壁微循环灌注具有可行性，有可能为临床提供一种全新的从微血管层面诊断ITBL的影像学手段。Objective To evaluate the value of contrast enhanced ultrasound（CEUS） in the diagnosis of ischemic type biliary lesion （ITBL） after liver transplantation. Methods Twenty-five liver transplantation recipients suspected with biliary complications were examined using CEUS. Percutaneous transhepatic cholangiography or endoscopic retrograde cholangiopancreatography confirmed the diagnosis. The enhancement patterns of the thickened hilum bile duct wall were observed. Results Enhancement patterns of bile duct wall could be divided into 3 sorts： ①No-enhancement, six cases, showed no-enhancement all along. ②Hypo-enhancing level,four cases, presented hypo-enhancing at arterial phase and persistent hypoor no-enhancing until late phase. ③Hyper enhancing level,fifteen cases,appeared as hyperor iso-enhancing at arterial phase and persistent isoor hypo enhancing until late phase. The enhancement pattern of bile duct wall showed significant difference （ P = 0.00）.Thirteen ITBL patients included 10 cases （76.9%） with noor hypo enhancement,3 patients （23.1%） with hyper-enhancement. However, all of 12 non ITBL cases appeared hyper-enhancing. Conclusions CEUS provides a new and effective method to estimate the mierocirculation of the bile duct wall. It may be help to early diagnosis of ITBL.

关 键 词：超声检查 微气泡 肝移植 胆管疾病 

分 类 号：R686[医药卫生—骨科学]