肝移植术后不同类型胆道狭窄的多层CT诊断价值

目的 探讨肝移植术后不同类型胆道狭窄的多层CT表现及诊断价值.方法 以55例经皮胆道造影(PTC)或内镜逆行胆道造影(ERC)证实的移植术后胆道狭窄患者为对象,分析缺血型胆道狭窄(IBS)23例及非缺血型胆道狭窄(NIBS)32例患者的肝内、外胆道及肝动脉病变情况,根据二项分布样本总体概率的Z检验比较两组多层CT表现差异.结果多层CT检查中,54/55例(98.2%)胆道狭窄患者发现不同程度胆管扩张,1例弥漫性肝内胆管狭窄、无肝内外胆管扩张的IBS患者漏诊.IBS患者肝门区胆管狭窄(21例,91.3%)、肝内胆管不均匀扩张(16例,69.6%)发生率显著高于NIBS患者(分别为4例,12.5%和12例,37.5%)(单侧P值<0.01);胆总管吻合口狭窄(8例,34.8%)、肝外胆管扩张(8例,34.8%)、肝内胆管均匀扩张(6例,26.1%)发生率显著低于NIBS患者(分别为27例,84.4%、29例,90.6%和20例,62.5%)(单侧P值<0.01).CTA发现16/23例IBS及5/32例NIBS患者肝动脉狭窄,IBS患者肝动脉狭窄发生率高(单侧P<0.01).IBS组5例合并肝内胆汁瘤及2例合并胆源性肝脓肿患者全部出现重度以上肝动脉狭窄.2/3例胆漏患者合并IBS,CTA发现1例肝动脉血栓、1例极重度肝动脉狭窄.结论 IBS、NIBS在胆道狭窄部位、继发性胆管扩张鄣位和肝内胆管扩张多层CT上有不同的表现特征,肝门区胆管狭窄及肝内胆管不均匀扩张为IBS主要表现;CTA还能发现相关血管病变,为临床治疗提供参考.

The role of multislice spiral CT in diagnosing different biliary strictures after liver transplantation

Objective To investigate CT features of biliary stricture developed after liver transplan-tation and to evaluate CT examination in diagnosing different biliary strictures. Methods Fifty-five patients with biliary stricture were enrolled in this study. The diagnosis was confirmed by percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiography (ERC). CT features were observed and a comparison of CT findings between ischemic biliary stricture group (IBS, n = 23) and non-ischemic bil...