肝移植术后腹腔感染的超声表现分析

目的探讨常规超声及超声造影在肝移植术后腹腔感染诊断中的应用价值。方法对我院肝移植术后证实为腹腔感染，超声资料完整的18例患者的临床表现及超声征象进行回顾性分析，注意治疗后复查的变化情况，总结其特点。结果18例腹腔感染患者中肝脓肿8例，腹膜腔感染5例，肾脓肿2例，胆源性肝脓肿并腹壁窦道感染1例，胆源性肝脓肿并腹膜腔感染1例，腹膜腔并腹壁切口感染1例。感染类型及超声征象：（1）肝脓肿：其中胆源性肝脓肿8例（均伴胆道并发症），5例伴肝动脉狭窄，常规超声和超声造影表现与非胆源性肝脓肿类似，但病灶多靠近肝脏周边，与胆管关系密切，部分与胆管相通；（2）6例腹膜腔感染，临床症状明显，且多次复查局限性积液持续存在，内部回声紊乱；（3）2例肾脓肿，均累及单肾，常规超声表现多为边界欠清的低回声团，内见细密回声或（和）层状低回声，彩色多普勒超声检查内部均无血流信号，超声造影显示的病灶数目多于常规超声、边界更清楚；（4）1例腹壁窦道感染为上腹壁不规则低回声带，边界欠清，并与肝脏相通；（5）1例腹壁切口感染为腹壁切口内混合回声区，彩色多普勒超声未见血流信号。结论常规超声和超声造影检查结合临床表现及治疗后复查情况，可较为准确的诊断肝移植术后的腹腔感染。对于常规超声诊断困难的病例，超声造影不仅可明确病灶数目，清晰显示病灶边界，而且可观察病灶的血流灌注，协助鉴别诊断，具有重要临床使用价值。

The analysis of ultrasonic manifestation in abdominal cavity infection after liver transplantation

Objective To explore the diagnostic value of general and contrast-enhanced ultrasound in abdominal cavity infection after liver transplantation. Methods Eighteen cases of abdominal cavity infection with diagnostic and integrated ultrasonic data in our hospital were retrospectively analyzed. The changes of clinical and ultrasonic manifestation were analysed before and after therapy. The feature was summarized. Results Among the 18 cases, there were eight hepatic abscesses, five peritoneal cavity infection, two nephropyosis, one biliary hepatic abscess with abdominal wall sinus infection, one biliary hepatic abscess with peritoneal cavity infection and one peritoneal cavity with abdominal wall incision infection. （ 1 ） Eight cases of hepatic abscess were with bile duct complications and five with hepatic artery stenosis. The general and contrast-enhanced ultrasonic manifestations were similar to non-biliary hepatic abscess. However, they were nearer to the periphery of liver, which had closer relationship and partly connected with bile ducts. （2） Among five peritoneal cavity infections, all of them had obvious clinical manifestation. The localized fluid existed persistently with mussy echo. （3） Two cases of nephropyosis both involved unilateral kidney. The general ultrasound showed hypoechoic region with poor-defined margin, compact or layered echo without blood flow. The contrast-enhanced ultrasound displayed more and well-defined margin lesions compared to the general ultrasound. （4） The sinus infection of abdominal wall showed irregular hypoechoic belt with poordefined margin in the upper abdominal wall, which had a connection with liver. （5） The infection of the abdominal wall incision showed no homogeneous echo and blood flow in the incision. Conclusions To combine the clinical manifestation and changes before and after the therapy, general and contrast-enhanced ultrasound can accurately diagnose the abdominal cavity infection after liver transplantation. For the cases that were difficult to be diagnosed by general ultrasound, contrast-enhanced ultrasound possesses important clinical value. Since it not only identifies the number of lesions and displays the margin clearly, but could observe the blood perfusion and be helpful for differential diagnosis.