肝移植术后胆泥超声声像图表现及其与预后相关性的初步探讨

吕艳; 廖梅; 曹君妍; 吴涛; 吴莉莉; 郑荣琴; 任杰

doi:10.3969/j.issn.1674-7445.2014.03.011

肝移植术后胆泥超声声像图表现及其与预后相关性的初步探讨

doi: 10.3969/j.issn.1674-7445.2014.03.011

510630 广州, 中山大学附属第三医院超声科

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
计量
- 文章访问数: 229
- HTML全文浏览量: 129
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2014-02-26
- 网络出版日期: 2021-01-19
- 刊出日期: 2014-05-15

Preliminary discussion of ultrasonograms of biliary sludge and its relationship with the prognosis of patients after liver transplantation

Department of Ultrasonography, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China

摘要

摘要: 目的探讨肝移植术后胆泥超声表现及其与预后的关系。方法回顾性分析36例肝移植术后胆泥患者的超声声像图表现, 按治疗结果分为不良疗效组和疗效稳定组, 比较两组间初次发现胆泥时的超声特点。结果缺血性胆道病变合并胆泥者在不良疗效组中占95%(19/20), 在疗效稳定组中则仅为13%(2/16), 差异有统计学意义(P < 0.05)。疗效稳定组的胆泥均位于肝门部(16/16), 胆泥与胆管壁分界清晰(14/16), 肝门部胆管壁无增厚(14/16), 肝内胆管未见扩张(14/16);不良疗效组胆泥分布范围广, 除肝门部外, 常累及肝内胆管(10/20), 胆泥与胆管壁分界模糊(15/20), 肝门部胆管壁增厚明显(16/20), 肝内胆管扩张(19/20);上述4项指标在两组间差异有统计学意义(均为P < 0.05)。结论在不同预后组间胆泥的声像图特点有差异, 对合并有缺血性胆道病变超声特点的胆泥, 提示预后较差, 可能需要进行积极的介入治疗。
- 肝移植 /
- 胆泥 /
- 超声
Abstract: Objective To investigate the ultrasonograms of biliary sludge and its relationship with the prognosis of patients after liver transplantation. Methods Ultrasonograms of 36 patients with biliary sludge after liver transplantation were retrospectively analyzed. These patients were divided into two groups according to the different treatment outcomes: poor prognosis group and favorable prognosis group. The characteristics of initial ultrasonograms of biliary sludge when they were found at first time compared between two groups. Results Biliary sludge combined with ischemic-type biliary lesions accounted for 95%(19/20) in poor prognosis group while 13%(2/16) in favorable prognosis group. There was significant difference between two groups(P < 0.05). In favorable prognosis group, biliary sludge was found locating in hepatic hilar region in all 16 cases (16/16) and the sludge had clear boundaries dissociated with bile duct walls were observed in 14 cases (14/16). There was no incrassation of bile duct walls in hepatic hilar region, nor dilation of intrahepatic bile ducts observed in 14 cases (14/16). In poor prognosis group, biliary sludge was observed widespread not only in hepatic hilar region but also in intrahepatic biliary ducts in 10 cases (10/20), and the boundaries between sludge and bile duct walls were vague in 15 cases (15/20). Obvious incrassation of bile duct walls in hepatic hilar region was observed in 16 cases (16/20), and dilation of intrahepatic bile ducts was observed in 19 cases (19/20). There were significant differences in the above 4 ultrasound features between two groups (all in P < 0.05). Conclusions There are differences in the ultrasonograms of biliary sludge between different prognosis groups. Biliary sludge combined with ischemic-type biliary lesions suggests a poor prognosis, which may need more active interventional treatments.
- Liver transplantation /
- Biliary sludge /
- Ultrasonography

HTML全文

图 1 两组肝移植术后患者的胆泥声像图

注：A图为疗效稳定组患者的胆泥声像图，胆总管供体段胆泥(箭头所示)呈条状低回声，与胆管壁分界清晰，胆管壁无明显增厚，确诊为胆道感染；B图为不良疗效组患者胆泥声像图，右肝管内胆泥(箭头所示)呈稍高回声，与胆管壁分界不清，肝内胆管不均匀扩张，确诊为ITBL

Figure 1. Ultrasonograms of biliary sludge of patients after liver transplantation in two groups

下载: 全尺寸图片幻灯片

表 1 两组患者的胆泥声像图表现比较

Table 1. Comparision of sonographic appearance of biliary sludge of patients between two groups

组别	n	胆泥位置		胆泥回声			胆泥与胆管壁分界		肝门部胆管壁		肝内胆管扩张		肝动脉参数
组别	n	仅肝门部	累及肝内	高回声	低回声	等回声	清	不清	增厚	无增厚	有	否	正常	异常
不良疗效组	20	10	10	14	3	3	5	15	16	4	19	1	15	5
疗效稳定组	16	16	0	5	7	4	14	2	2	14	2	14	15	1
χ²值		11.077		5.631			13.932		16.200		24.891		2.250
P值		<0.001		0.06			<0.000		<0.000		<0.000		0.196

下载: 导出CSV

参考文献(17)

[1]	Zhu XD, Shen ZY, Chen XG, et al. Pathotyping and clinical manifestations of biliary cast syndrome in patients after an orthotopic liver transplant[J]. Exp Clin Transplant,2013,11(2):142-149. doi: 10.6002/ect
[2]	易述红,易慧敏,傅斌生,等. 联合肝门板的肝门-空肠吻合术治疗肝移植术后缺血性胆道病变患者[J/CD]. 中华肝脏外科手术学电子杂志,2013,2(1):13-16. Yi SH, Yi HM, Fu BS, et al. Roux-en-Y hepatojejunostomy combined with hilar plate in the treatment of ischemic-type biliary[J/CD]. Chin J Hepat Surg:Electronic Edition, 2013,2(1):13-16.
[3]	Yang YL, Shi LJ, Lin MJ, et al. Clinical analysis and significance of cholangiography for biliary cast/stone after orthotopic liver transplantation[J]. J Nanosci Nanotechnol,2013,13(1):171-177. doi: 10.1166/jnn.2013.6790
[4]	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.
[5]	Daneshi M, Rajayogeswaran B, Peddu P, et al. Demonstration of an occult biliary-arterial fistula using percutaneous contrast-enhanced ultrasound cholangiography in a transplanted liver[J]. J Clin Ultrasound, 2014, 42(2):108-111. doi: 10.1002/jcu.22048
[6]	张剑文,傅斌生,张彤,等. 再次肝移植治疗移植肝缺血型胆道损伤15例报告[J].器官移植,2012,3(4):190-194. http://www.organtranspl.com/browse/detail/qkid/32/id/606.html Zhang JW, Fu BS, Zhang T, et al. Retransplantation for ischemic type biliary lesion of the first transplanted live graft: 15 cases report[J]. Organ Transplant,2012,3(4):190-194. http://www.organtranspl.com/browse/detail/qkid/32/id/606.html
[7]	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
[8]	Yang YL, Zhang C, Lin MJ, et al. Biliary casts after liver transplantation: morphology and biochemical analysis[J]. World J Gastroenterol, 2013, 19(43):7772-7777. doi: 10.3748/wjg.v19.i43.7772
[9]	Yoon JH. Biliary papillomatosis: correlation of radiologic findings with percutaneous transhepatic cholangioscopy[J]. J Gastrointestin Liver Dis,2013,22(4):427-433. http://cn.bing.com/academic/profile?id=2185081416&encoded=0&v=paper_preview&mkt=zh-cn
[10]	Sheng R, Ramirez CB, Zajko AB, et al. Biliary stones and sludge in liver transplant patients: a 13-year experience[J]. Radiology,1996,198(1):243-247. doi: 10.1148/radiology.198.1.8539387
[11]	易述红,陈规划,陆敏强,等.原位肝移植术后胆道结石的临床研究[J].中华肝胆外科杂志,2005,11(4):234-236. Yi SH, Chen GH, Lu MQ, et al. Clinical study on biliary stones and sludge following orthotopic liver transplantation[J]. Chin J Hepatobiliary Surg, 2005, 11(4):234-236.
[12]	曾婕,任杰,郑荣琴,等.超声检测肝门部胆管在鉴别肝移植术后胆道狭窄类型中的价值[J].中华超声影像学杂志,2012,21(5):394-396.. Zeng J, Ren J, Zheng RQ, et al. Identification of different types of biliary strictures after orthotopic liver transplantation by hilar bile duct using ultrasonography[J]. Chin J Ultrason,2012,21(5):394-396.
[13]	Paik WH, Lee SH, Ryu JK, et al. Long-term clinical outcomes of biliary cast syndrome in liver transplant recipients[J]. Liver Transpl,2013,19(3):275-282. doi: 10.1002/lt.v19.3
[14]	Kinner S, Hunold P. Detection of cast in biliary cast syndrome[J]. Radiology,2013,266(1):366-367. doi: 10.1148/radiol.12121350
[15]	Apestegui C, Ciccarelli O, Lerut J. Biliary cast syndrome after liver transplantation[J]. ANZ J Surg,2012,82(11):849-850. doi: 10.1111/ans.2012.82.issue-11
[16]	Morelli J, Mulcahy HE, Willner IR, et al. Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement[J]. Gastrointest Endosc,2003,58(3):374-379. doi: 10.1067/S0016-5107(03)00011-7
[17]	Chan CH, Donnellan F, Byrne MF, et al. Response to endoscopic therapy for biliary anastomotic strictures in deceased versus living donor liver transplantation[J]. Hepatobiliary Pancreat Dis Int,2013,12(5):488-493. doi: 10.1016/S1499-3872(13)60077-6