肝移植术后胆道并发症的MRCP表现  

MRCP Findings of Biliary Complication after Liver Transplantation

作　　者：何炳均[1] 刘静静[1] 王劲[1] 颜荣华[1] 梁莹莹[1] 任泠斓[1] 单鸿[1] 

机构地区：[1]中山大学附属第三医院放射科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2012年第1期85-88,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金研究团队项目(05200177);广东省科技计划项目(2008B060600034);广东省自然科学基金(1015100 8901000188);广东省大学生创新实验项目(1055810085)

摘　　要：【目的】探讨肝移植术后胆道并发症的MRCP影像学表现。【方法】根据PTC或ERCP检查、病理结果及临床确诊的缺血性胆管病变(ITBL)32例和吻合口狭窄(AS)9例患者,对其MRCP图像进行观察。【结果】根据胆管病变累及的部位和范围将ITBL分为肝门型(Ⅰ型)、弥漫型(Ⅱ型)和肝内型(Ⅲ型)。Ⅰ型15例,MRCP示胆总管、肝总管、汇合部、左右肝管及其二级分支胆管显影不良或不显影。Ⅱ型13例,MRCP示广泛性肝内、外胆管不规则狭窄或扩张,胆管间断显影。Ⅲ型4例,MRCP示仅肝内胆管不规则、节段性扩张,扩张不成比例、粗细不均呈"串珠"样。ITBL组中伴有供肝肝总管、汇合部及左和(或)右肝管管腔内胆泥形成25例(78.1%,25/32),MRCP上表现为管腔内不规则充盈缺损影。伴有肝门部积液4例,胆汁湖3例。MRCP上AS主要表现为吻合口处局限性狭窄,上段管腔不同程度继发性扩张。AS组中胆管管腔内伴有胆泥形成3例(33.3%,3/9)。【结论】MRCP可全面观察肝移植术后胆道并发症中胆管病变的部位和范围,提供胆管病变的整体信息。在肝移植术后胆道并发症中的诊断及分型中具有重要的参考价值,是临床工作中一种简单、实用、无创的检查方法。[ Objective ] To discussion the findings of MRCP on ischemic-type biliary lesions after liver transplantation. [ Methods ] Thirty-two cases with ischemic-type biliary lesions （ITBL） and nine cases with anastomotic strictures （AS） after liver transplantation on bases of PTC or ERCP examination and pathology were selected. MRCP images of biliary tree were observed. [ Results ] ITBL was classified into three types on the base of the location and range of bile duct lesion： porta hepatis type （ I type）, extensive type （ II type） and intrahepatic type （ m type）. Fifteen cases were I type. MRCP mainly showed absent or thin bile signal at the level of common bile duct, common hepatic duct, confluence and left or right hepatic duct and second level bile ducts. Thirteen cases were I1 type. Segmental bile signal, irregular stenosis and dilation at the level of intrahepatic and extrahepatic bile ducts was observed on MRCP. Four cases were HI type. Irregular, segmental and string-of-beads stenosis and dilation at the level of intrahepatic small bile ducts can be seen on MRCP. And 25 ITBL cases （78.1%, 25/32） had sludge formation in the lumen of donor common hepatic duct, confluence and left and （or） right hepatic duct. MRCP presents signal filling defects in the lumen. Porta hepatis effusion and bile lake have 4 and 3 cases, respectively. AS appears on MRCP as local stenosis of anastomosis with dilation of the bile ducts proximal to the stenosis. Three AS patients （33.3%, 3/9） had sludge formation in the lumen of bile ducts. [ Conclusions] MRCP, as a simple, practical and non-invasive way, plays an important role in the diagnosis and classification of biliary complications after liver transplantation with the ability of showing the location and range of bile duct lesion.

关 键 词：肝移植:胆道并发症:磁共振胰胆管成像 

分 类 号：R816.5[医药卫生—放射医学]