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超声检查在活体肝移植受体术后胆道并发症诊断中的应用

廖梅 任杰 郑荣琴 吕艳

廖梅, 任杰, 郑荣琴, 等. 超声检查在活体肝移植受体术后胆道并发症诊断中的应用[J]. 器官移植, 2014, 5(2): 85-88,127. doi: 10.3969/j.issn.1674-7445.2014.02.006
引用本文: 廖梅, 任杰, 郑荣琴, 等. 超声检查在活体肝移植受体术后胆道并发症诊断中的应用[J]. 器官移植, 2014, 5(2): 85-88,127. doi: 10.3969/j.issn.1674-7445.2014.02.006
Liao Mei, Ren Jie, Zheng Rongqin, et al. Application of ultrasonography in evaluating biliary complications after living donor liver transplantation[J]. ORGAN TRANSPLANTATION, 2014, 5(2): 85-88,127. doi: 10.3969/j.issn.1674-7445.2014.02.006
Citation: Liao Mei, Ren Jie, Zheng Rongqin, et al. Application of ultrasonography in evaluating biliary complications after living donor liver transplantation[J]. ORGAN TRANSPLANTATION, 2014, 5(2): 85-88,127. doi: 10.3969/j.issn.1674-7445.2014.02.006

超声检查在活体肝移植受体术后胆道并发症诊断中的应用

doi: 10.3969/j.issn.1674-7445.2014.02.006
基金项目: 

国家自然科学基金 81371554

详细信息
    通讯作者:

    任杰,Email:renjieguangzhou@126.com

  • 中图分类号: R617

Application of ultrasonography in evaluating biliary complications after living donor liver transplantation

  • 摘要:   目的   探讨超声检查在活体肝移植术后胆道并发症诊断中的临床应用。   方法   对21例成人右半肝活体移植受体术后进行超声检查,观察移植肝及其胆道声像图表现,与经皮经肝穿刺胆道造影引流(PTCD)等影像学结果相对比。   结果   21例病例经PTCD及临床随访证实为胆管吻合口狭窄5例,胆泥1例,胆漏1例。超声检查能够诊断并与之相符5例,为4例吻合口狭窄及1例胆泥,胆漏病例可见肝周积液。其中4例胆管吻合口狭窄病例超声诊断时间均明显早于临床出现黄疸或血清胆红素升高的时间。   结论   在活体肝移植术后胆道并发症的诊断中,超声检查操作简便、无创、可重复性强、准确性较高,可早期诊断胆管并发症,具有重要的临床应用价值。

     

  • 图  1  活体肝移植术后并发吻合口狭窄受者的超声表现

    注:活体右半肝移植术后1个月,A图超声图像显示肝内胆管轻-中度均匀扩张(红色箭头所示),管腔透声性良好,右肝管显示不清。B图PTCD示肝内胆管较均匀扩张,胆管吻合口处狭窄

    Figure  1.  Ultrasonography findings of a recipient with anastomotic stenosis after LDLT

    图  2  活体肝移植术后并发胆泥受者的超声表现

    注:A图为活体右半肝移植术后3个月的超声图像,显示右肝管轻度扩张,右肝管近吻合口处可见团絮状稍高回声团(红色箭头所示),与胆管壁分界清晰,后方不伴声影。B图为经保守治疗3个月后复查的超声图像,示右肝管无扩张,管腔内稍高回声团消失,管腔内未见胆泥(红色箭头所示)

    Figure  2.  Ultrasonography of a recipient with biliary sludge after LDLT

    表  1  7例活体肝移植术后胆道并发症患者的临床资料

    Table  1.   Clinical data of 7 patients with biliary complications after LDLT


    序号
    供体胆管
    有否变异
    胆管吻合
    方式
    术后超声发现胆道
    异常时间(d)
    术后临床表现/
    发生时间
    并发症类型确诊手段
    例1端端吻合10 血清胆红素与
    转氨酶升高/2周
    吻合口狭窄PTCD
    例2端端吻合5黄疸/4个月吻合口狭窄PTCD
    例3肝总管分三支:
    左肝管、右前支、
    右后支胆管
    供体右前、右后叶
    胆管分别与受体左右
    肝管端端吻合
    6胆红素持续
    升高/1周
    吻合口狭窄PTCD
    例4端端吻合90发热/3个月右肝管胆泥临床随访
    例5端端吻合15黄疸/4个月吻合口狭窄PTCD
    例6右后支胆管
    由左肝管发出
    端端吻合15血清胆红素与
    转氨酶突然升高/15 d
    胆漏PTCD
    例7端端吻合-黄疸/12个月吻合口狭窄PTCD
    下载: 导出CSV
  • [1] Julka KD, Lin TS, Chen CL, et al. Reconstructing single hepatic artery with two arterial stumps: biliary complications in pediatric living donor liver transplantation[J]. Pediatr Surg Int,2014,30(1):39-46. doi: 10.1007/s00383-013-3436-z
    [2] 张子宏,夏强,张建军,等.活体右半供肝移植后胆道并发症的中长期随访研究及危险因素分析[J].中华器官移植杂志,2012,33(4):208-211.

    Zhang ZH, Xia Q, Zhang JJ, et al. Risk factors and long-term follow-up results for biliary complications after right lobe living donor liver transplantation[J]. Chin J Organ Transplant,2012,33(4):208-211.
    [3] Na GH, Kim DG, Choi HJ, et al. Interventional treatment of a biliary stricture after adult right-lobe living-donor liver transplantation with duct-to-duct anastomosis[J]. HPB,2013, DOI: 10.1111/hpb. 12151[Epub ahead of print].
    [4] Hwang S, Lee SG, Sung KB, et al. Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation[J]. Liver Transpl,2006,12(5):831-838. doi: 10.1002/(ISSN)1527-6473
    [5] Zimmerman MA, Baker T, Goodrich NP, et al. Development, management, and resolution of biliary complications after living and deceased donor liver transplantation:a report from the adult-to-adult living donor liver transplantation cohort study consortium[J]. Liver Transpl,2013,19(3):259-267. doi: 10.1002/lt.v19.3
    [6] Yaprak O, Dayangac M, Akyildiz M, et al. Biliary complications after right lobe living donor liver transplantation:a single-centre experience[J]. HPB, 2012,14(1):49-53. doi: 10.1111/j.1477-2574.2011.00401.x
    [7] Potthoff A, Hahn A, Kubicka S, et al. Diagnostic value of ultrasound in detection of biliary tract complications after liver transplantation[J]. Hepat Mon,2013,13(1):e6003. http://cn.bing.com/academic/profile?id=1979725153&encoded=0&v=paper_preview&mkt=zh-cn
    [8] Singh AK, Nachiappan AC, Verma HA, et al. Postoperative imaging in liver transplantation:what radiologists should know[J]. Radiographics,2010,30(2):339-351. doi: 10.1148/rg.302095124
    [9] Beswick DM, Miraglia R, Caruso S, et al. The role of ultrasound and magnetic resonance cholangiopancreatography for the diagnosis of biliary stricture after liver transplantation[J]. Eur J Radiol,2012,81(9):2089-2092. doi: 10.1016/j.ejrad.2011.07.008
    [10] 毛永江,郑荣琴,任杰,等.肝移植术后胆管狭窄的超声表现[J].中华超声影像学杂志,2008,17(12):1045-1047.

    Mao YJ, Zheng RQ, Ren J, et al. Ultrasonographic characteristics of biliary stricture after orthotopic liver transplantation[J]. Chin J Ultrasonogr,2008,17(12):1045-1047.
    [11] Shindoh J, Hasegawa K, Kokudo N. Image of the month. asymptomatic dilatation of the intrahepatic biliary tree due to thrombosed pericholedochal varices (portal biliopathy)[J]. Clin Gastroenterol Hepatol,2011,9(2):e14-e15. doi: 10.1016/j.cgh.2010.09.021
    [12] Girometti R, Cereser L, Como G, et al. Biliary complications after orthotopic liver transplantation:MRCP findings[J]. Abdom Imaging,2008,33(5):542-554. doi: 10.1007/s00261-007-9316-z
    [13] Duailibi DF, Ribeiro MA Jr. Biliary complications following deceased and living donor liver transplantation:a review[J]. Transplant Proc,2010,42(2):517-520. doi: 10.1016/j.transproceed.2010.01.017
    [14] Lei J, Yan L, Wang W. Comparison of the outcomes of patients who underwent deceased-donor or living-donor liver transplantation after successful downstaging therapy[J]. Eur J Gastroenterol Hepatol,2013,25(11):1340-1346. doi: 10.1097/MEG.0b013e3283622743
    [15] Ruiz A, Lemoinne S, Carrat F, et al. Radiologic course of primary sclerosing cholangitis:assessment by three-dimensional magnetic resonance cholangiography and predictive features of progression[J]. Hepatology,2014,59(1):242-250. doi: 10.1002/hep.26620
    [16] Itri JN, Heller MT, Tublin ME. Hepatic transplantation:postoperative complications[J]. Abdom Imaging,2013,38(6):1300-1333. doi: 10.1007/s00261-013-0002-z
    [17] Munday GS, Eng M, Klink F, et al. An uncommon neurologic complication following orthotopic liver transplantation[J]. Am J Transplant,2013,13(9):2496-2498. doi: 10.1111/ajt.12346
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出版历程
  • 收稿日期:  2013-12-29
  • 网络出版日期:  2021-01-26
  • 刊出日期:  2014-03-15

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