肝移植术后不同类型胆道狭窄的多层CT诊断价值  

The role of multislice spiral CT in diagnosing different biliary strictures after liver transplantation

作　　者：孟晓春[1] 朱康顺[1] 徐川[1] 彭令荣[1] 江婷[1] 刘凌云[1] 单鸿[1] 

机构地区：[1]中山大学附属第三医院放射科,广州510630

出　　处：《介入放射学杂志》2009年第3期200-204,共5页Journal of Interventional Radiology

基　　金：广东省自然科学基金团队研究资助项目(05200177)

摘　　要：目的探讨肝移植术后不同类型胆道狭窄的多层CT表现及诊断价值。方法以55例经皮胆道造影(PTC)或内镜逆行胆道造影(ERC)证实的移植术后胆道狭窄患者为对象,分析缺血型胆道狭窄(IBS)23例及非缺血型胆道狭窄(NIBS)32例患者的肝内、外胆道及肝动脉病变情况,根据二项分布样本总体概率的Z检验比较两组多层CT表现差异。结果多层CT检查中,54/55例(98.2%)胆道狭窄患者发现不同程度胆管扩张,1例弥漫性肝内胆管狭窄、无肝内外胆管扩张的IBS患者漏诊。IBS患者肝门区胆管狭窄(21例,91.3%)、肝内胆管不均匀扩张(16例,69.6%)发生率显著高于NIBS患者(分别为4例,12.5%和12例,37.5%)(单侧P值<0.01);胆总管吻合口狭窄(8例,34.8%)、肝外胆管扩张(8例,34.8%)、肝内胆管均匀扩张(6例,26.1%)发生率显著低于NIBS患者(分别为27例,84.4%、29例,90.6%和20例,62.5%)(单侧P值<0.01)。CTA发现16/23例IBS及5/32例NIBS患者肝动脉狭窄,IBS患者肝动脉狭窄发生率高(单侧P<0.01)。IBS组5例合并肝内胆汁瘤及2例合并胆源性肝脓肿患者全部出现重度以上肝动脉狭窄。2/3例胆漏患者合并IBS,CTA发现1例肝动脉血栓、1例极重度肝动脉狭窄。结论IBS、NIBS在胆道狭窄部位、继发性胆管扩张部位和肝内胆管扩张多层CT上有不同的表现特征,肝门区胆管狭窄及肝内胆管不均匀扩张为IBS主要表现;CTA还能发现相关血管病变,为临床治疗提供参考。Objective To investigate CT features of biliary stricture developed after liver transplantation and to evaluate CT examination in diagnosing different biliary strictures. Methods Fifty-five patients with biliary stricture were enrolled in this study. The diagnosis was confirmed by percutaneous transhepatic cholangiography （PTC） or endoscopic retrograde eholangiography （ERC）. CT features were observed and a comparison of CT findings between isehemic biliary stricture group （IBS, n = 23） and non-ischemic biliary stricture group （NIBS, n = 32） was made. The related statistic analysis was conducted. Results PTC or ERC exam confirmed IBS in ：23 cases and NIBS in 32 cases. With multisliee spiral CT scan, biliary dilatation in different degree was found in 54 cases （98.18%）, and one case of IBS missed diagnosis, who had diffuse intrahepatic bile duct stricture but no extrahepatic biliary dilatation. The biliary stricture at hepatic hilum and the irregular dilatation of intrahepatic bile duct in IBS group were 91.30% and 69.57% respectively, which were siguifieantly higher than that in NIBS group （12.50% and 37.50% respectively）, with the unilateral P value 〈 0.01. The occurrence of the anastomotic stricture, the extrahepatic dilatation and the regular dilatation of intrahepatic bile duct in IBS group was 34.78%, 34.78% and 26.09% respectively, which was significantly lower than that in NIBS group （84.38%, 90.63% and 62.5% respectively）, with the unilateral P value 〈 0.01. CTA detected hepatic artery stenosis in 16 amidst 23 cases with IBS and 5 amidst 32 cases with NIBS. The incidence of hepatic artery stenosis was markedly higher in IBS group （unilateral P value 〈 0.01 ）. In IBS group, severe hepatic artery stenosis was developed in 5 cases with intrahepatic biloma and in 2 cases with biliary abscess. Two-thirds cases with bile leak were accompanied by IBS. On CTA scan, hepatic artery thrombosis was found in one and severe hepatic artery stenosis in another one. Conclusion IBS an

关 键 词：肝移植 胆道并发症 体层摄影术 X线计算机 胆道造影术 

分 类 号：R657.3[医药卫生—外科学] R816.5[医药卫生—临床医学]