肝移植术后肝动脉假性动脉瘤的诊断学特征并文献复习  

Diagnostic characteristics and literature review of hepatic artery pseudoaneurysm after liver transplantation

作　　者：吴丽兰 汤敏 Wu Lilan;Tang Min(Department of Radiology,the Xiamen Branch of Zhongshan Hospital Affiliated to Fudan University,Xiamen 361015,China;Department of Radiology,the Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院厦门医院放射科,361015 [2]复旦大学附属中山医院放射科,上海200032

出　　处：《中华诊断学电子杂志》2020年第1期44-48,共5页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：上海市临床重点专科项目(W2019-018)

摘　　要：目的探讨肝移植术后肝动脉假性动脉瘤破裂伴胆道出血的临床诊断学特征。方法回顾性分析复旦大学附属中山医院肝外科收治的1例肝移植术后伴发胆管吻合口狭窄,反复行经内镜逆行性胆道支架引流(ERBD)术后,肝假性动脉瘤破裂伴胆道出血患者的诊疗经过,并复习相关文献。结果患者因“反复发热伴黄疸1个月余”于2017年7月6日入院,患者肝移植术后4年,多次行ERBD。患者入院行经皮肝穿刺胆管造影检查发现肝右动脉显影,肝动脉造影确诊肝右动脉假性动脉瘤,破溃至胆道,行肝动脉假性动脉瘤栓塞术和经皮肝穿刺胆道引流术(PTCD),术后发热及黄疸症状明显改善。结论肝移植术后,有医源性有创治疗史患者,不明原因反复发热伴持续黄疸时,需术后定期行CT血管成像(CTA)检查作为随访,排除肝假性动脉瘤破裂胆道出血可能。Objective To investigate the clinical diagnostic features of hepatic artery pseudoaneurysm(HAP)rupture with biliary tract hemorrhage after liver transplantation.Methods A case of HAP rupture with biliary tract hemorrhage who repeatedly underwent endoscopic retrograde biliary drainage(ERBD)due to biliary anastomotic stenosis after liver transplantation,admitted to Department of Liver Surgery of Zhongshan Hospital Affiliated to Fudan University was analyzed retrospectively,and the relevant literatures were reviewed.Results The patient was admitted for“fever with jaundice for more than one month”on July 6,2017 after liver transplantation 4 years ago,and repeatedly underwent ERBD surgeries.The patient underwent percuteneous transhepatic cholangio drainage(PTCD)and the right hepatic artery imaging was found.Hepatic angiography confirmed the pseudoaneurysm was located in the right hepatic artery and it ruptured to the biliary tract.After embolization of HAP and PTCD,the symptoms of fever and jaundice were significantly improved.Conclusion After liver transplantation,patients with iatrogenic invasive treatment history and unexplained recurrent fever with persistent jaundice should be regularly followed up with computer tomography angiography(CTA)to exclude the possibility of hemobilia due to HAP rupture.

关 键 词：肝动脉假性动脉瘤 肝移植 磁共振成像 血管造影术 数字减影 

分 类 号：R657.3[医药卫生—外科学]