超声在诊断肝移植术后胆道并发症中的应用价值

目的探讨超声在诊断肝移植术后胆道并发症中的应用价值。方法回顾性分析78例肝移植术后胆道并发症的资料。结果 78例中胆道并发症13例(16.7%),其中胆漏2例(15.4%),胆道梗阻8例(61.5%),胆泥形成2例(15.4%),胆管结石1例(7.7%)。结论超声在诊断肝移植术后胆道并发症中起到极其重要的作用。     

肝移植术后胆道并发症ERCP表现及内窥镜介入治疗

目的探讨肝移植术后胆道并发症的原因及影像学表现,并对部分并发症进行内窥镜介入治疗,以提高肝移植的成功率。方法通过十二指肠镜逆行胰胆管造影(ERCP)检查对肝移植术后胆道异常改变11例资料进行回顾性分析,并根据检查结果做相应的内窥镜下介入治疗。结果通过ERCP检查,对11例肝移植术后患者出现梗阻性黄疸原因得到明确诊断,其中,胆道胆泥形成2例,胆管吻合口狭窄6例,胆道腹腔漏3例。并对2例胆道胆泥进行了乳头括约肌切开(EST) 网蓝胆泥取出术;5例吻合口狭窄行气囊扩张或塑料内支架内引流(ERBD)及2例胆道腹腔漏行鼻胆管引流治疗(ENBD),治疗效果确切,经有针对性的预防和治疗后,除2例胆道腹腔漏分别于肝移植术后6月及11月病死和1例因胆管吻合口处完全阻塞未能放置内支架引流管,导致肝内胆汁淤积症并肝硬化及肝功能失代偿病死外,其余患者均痊愈出院,现仍长期存活,总生存率为72.7%。结论肝移植术后一旦怀疑胆道并发症时应及时行ERCP检查,并根据检查结果做内窥镜介入治疗。胆道并发症的及时发现和处理将可能使患者较快痊愈。     

肝移植术后并发胆道狭窄和胆泥淤积影像诊断及介入治疗

目的:评价肝移植术后胆道狭窄和胆泥淤积影像诊断及介入治疗的价值。方法:对39例肝移植术后并发胆道狭窄和胆泥淤积的影像诊断及介入治疗进行回顾性分析。结果:超声、T型管胆道造影、CT和MRI检查诊断胆道狭窄伴胆泥形成39例,38例介入治疗后胆道梗阻症状明显缓解;1例介入治疗后胆道梗阻症状未明显改善,后行外科胆管修补术。结论:T型管胆道造影或直接经皮胆道造影对肝移植术后胆道狭窄和胆泥淤积诊断特异性及敏感性最高,放射介入和内镜介入技术对其均发挥重要的治疗作用。     

彩色多普勒超声在原位肝移植术后黄疸鉴别诊断中的价值

目的:探讨彩色多普勒超声(CDFI)在原位肝移植术后黄疸鉴别诊断中的应用价值。方法:使用彩色多昔勒超声观察18例原位肝移植术后发生黄疸患者的肝脏动静脉血流变化及胆管、肝实质声像图改变,主要观察指标有最大血流速度、时间平均血流速度(TAV)、阻力指数(RI)及胆管内径,并结合临床资料、肝穿刺活检病理结果和内镜逆行胰胆管造影(ERCP)表现等进行综合分析。结果:18例患者于术后6天-5个月发生黄疸,持续时间为12天-1年。其中13例为胆道并发症,5例为胆总管吻合口狭窄,2例为慢性胆管炎,2例为肝内胆管结石,1例为左肝管胆泥形成并霉菌感染,3 例为肝内胆管轻度扩张,其余5例经肝穿刺活检证实为轻度急性排斥反应4例、临界急性排斥反应1例。结论:彩色多普勒超声成像技术对原位肝移植术后黄疸具有重要的鉴别诊断价值,对临床医生判断病情有重要意义。     

超声在肝移植术后胆道并发症诊治中的应用

目的:探讨超声在肝移植术后胆道并发症诊治中的价值.材料和方法: 6例实施肝移植术后临床拟诊胆道并发症的患者,以二维超声检查移植肝及肝周情况,以彩色多普勒超声评估肝动脉、下腔静脉血流,并与其他影像学检查相对比.结果: 胆系梗阻3例(2例合并肝内多发胆汁肿)、胆管内胆泥形成1例、胆漏2例(在超声引导下置管引流).肝动脉血栓2例.肝流出道狭窄合并血栓1例.结论: 超声在肝移植术道并发症的诊治中有着重要的应用价值.     

肝移植术后胆系并发症的T管造影表现

目的 探讨肝移植术后胆系并发症的T管造影表现及其意义。资料与方法 搜集52例肝移植术后T管造影病例中发生胆系并发症的患者24例，其中男20例，女4例，年龄21～64岁。所有病例均行T管造影，并将X线表现与肝穿刺病理所见对照。结果并发症发生率为46．1％(24／52)。T管造影表现：(1)9例早期胆汁淤积症，T管造影无胆管梗阻，但肝内胆树稀疏，分支细，有时呈“垂柳状”外观；(2)10例胆总管吻合口胆瘘，表现为吻合口对比剂外漏，形成不规则状阴影；(3)5例胆管吻合口狭窄，表现为胆总管吻合口的不规则形充盈缺损，对比剂经吻合口排人远段胆管困难；(4)5例胆管内结石／胆泥形成，表现为胆管内充盈缺损；(5)6例胆管炎，肝内胆管细小，走行僵硬，胆管炎严重者可表现为胆管近肝门段狭窄、远段扩张的独特外观；(6)3例肝外胆管吻合后过长，长度超过13cm。肝移植术后胆管并发症的患者T管造影表现可同时出现上述征象1～4种。结论 T管造影可以明确肝移植术后的胆管并发症，对肝移植术后胆系的评价具有重要的价值，是肝移植术后常规检查手段之一。     

胆道术后并发症的MRI表现分析

目的　明确胆道术后综合征的MRI表现,寻找其真正病因。方法　回顾性分析 41例胆道术后并发症的上腹部MRI检查资料,观察其有无胆管扩张、狭窄、胆管炎、残余结石、残余胆囊等改变。结果　41例胆道术后并发症患者中 38例有胆道异常改变,其中胆管扩张 20例,胆管结石 16例,胆管炎 13例,胆管狭窄 7例,肝门胆管肿瘤 3例。胆管扩张多在术后 3月内出现,胆管炎症和狭窄多在术后半年以后出现。结论　胆道术后并发症主要由胆管扩张、狭窄和残留结石所致,MRI是诊断胆道术后并发症敏感而有效的手段。     

经T管窦道网篮取泥治疗肝移植术后胆泥综合症

目的探讨经T管窦道网篮取泥在肝移植术后胆泥综合症治疗中的应用价值。 方法回顾性分析2008年1月～ 2013年5月,经T管窦道网篮取泥治疗肝移植术后胆泥综合症的39例病人。所有病人均于术后3个月经T管造影诊断为胆泥形成。所有病人均采用3F网篮取除胆管内胆泥,并对伴有胆道狭窄的病人行球囊扩张,最后留置6~10F引流管。 结果39例病人中29例1次性完整取出胆树状铸型胆泥,10例取出部分絮状胆泥,6例病人因胆泥复发再次行经T管窦道网篮取泥治疗。除3例病人术后并发严重胆管炎外,无其他与介入治疗相关并发症发生。 结论经T管窦道网篮取泥可早期解除胆管梗阻,可作为治疗肝移植术后早期胆管内胆泥的一种方法。     

肝移植术后并发症的诊断与处理

本文总结回顾了3例肝移植术后胆道并发症的诊断及处理。其中,肝移植术后胆泥形成导致胆管结石1例,胆肠吻合口狭窄1例,肝外胆管全程坏死1例。分别予以胆管切开取石,经皮经肝胆道金属支架置入及肝门部胆管与空肠盆氏吻合处理。1例恢复,1例出现肝移植以外并发症死亡,1例感染死亡。文章对胆道并发症的发病原因进行分析,认为供体胆管冷缺时间,胆管壁供血及感染是引起上述并发症的重要原因。手术、金属支架置入等是可选择的治疗方法。     

肝移植术后胆道并发症的多层螺旋CT诊断

目的 评价MSCT在诊断肝移植术后胆道并发症中的价值.方法 83例原位肝移植术后患者因临床和生化检查可疑胆道并发症行MSCT增强检查.胆道并发症的确诊依据为直接胆道造影69例、移植肝病理11例、肝管空肠吻合术3例.分析CT诊断胆道并发症的能力,计算其敏感度、特异度、准确度、刚性预测值和阴性预测值,并用x2检验比较胆管吻合口狭窄和非吻合口狭窄的CT特征.结果 83例中,62例(74.7%)证实有胆道并发症,其中胆管吻合口狭窄32例,非吻合口狭窄21例,胆管结石16例(12例合并胆管狭窄),胆总管吻合口漏5例,胆汁瘤4例(合并胆管狭窄)、胆源性肝脓肿2例(合并胆管狭窄).CT诊断胆管狭窄的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为90.6%、86.7%、89.2%、92.3%和83.9%.CT对胆管结石、胆总管吻合口漏、胆汁瘤、胆源性肝脓肿均能正确诊断,无漏诊和误诊.非吻合口狭窄表现为胆管不均匀扩张的发生率(71.4%,15/21)显著高于吻合口狭窄者(25.0%,8/32;P<0.01),而肝外胆管扩张(33.3%,7/21)和胆管均匀扩张(14.3%,3/21)的发生率均显著低于吻合口狭窄者(84.4%,27/32和68.8%,22/32;P<0.01).非吻合口狭窄肝动脉缺血的发生率(66.7%,14/21)明显高于吻合口狭窄者(15.6%,5/32;P<0.01).结论 MSCT对诊断肝移植术后胆道并发症具有重要价值,还可初步诊断胆管狭窄类型;肝动脉缺血是胆管非吻合口狭窄的重要原因.     

肝移植术后早期胆道并发症65例诊治体会

目的探讨肝移植术后早期胆道并发症的诊断和治疗。方法回顾性分析了我院2006年5月～2008年3月以来成功实施的65例肝移植的临床资料。其中尸肝移植54例，亲体肝移植11例，女性占16．92％（11／65），男性占83．08％（54／65）。结果本组65例肝移植患者其中有8例3个月内出现胆道早期并发症，发生率为12．31％（8／65），分别为胆漏3例，胆汁瘤1例，肝内胆汁湖1例，胆泥形成1例，胆道狭窄2例。女性患者早期胆道并发症发生率为9．09％（1／11），男性患者早期胆道并发症发生率为12．96％（7／54）。8例患者中，留置T管引流1例，未留置T管引流7例。治愈6例，好转2例，死亡0例（0％）。其中3例术后3d内出现单纯胆漏，通过留置的腹腔引流管得到及时的诊断，同时应用留置的腹腔引流管持续引流4周～2月后得到治愈。5例经B超、MRCP、ERCP得到诊断；1例胆汁瘤和1例肝内胆汁湖通过B超引导下穿刺引流而得到治愈；1例胆泥形成通过ERCP进行胆道冲洗后好转出院；2例通过ERCP进行球囊扩张或者放置支架后好转出院。结论肝移植术后早期胆道并发症的诊断主要手段是留置的腹腔引流管、B超、MRCP、ERCP等：肝移植术中留置的腹腔引流管对于肝移植术后早期胆漏的治疗起着特殊的作用：B超引导下穿刺引流是治疗胆汁瘤、胆汁湖的重要手段；ERCP下胆道冲洗对胆泥形成非常有效．ERCP下球囊扩张或者放置胆道支架对胆道狭窄的治疗很有效。     

肝移植术后胆系造影的临床价值(附20例报告)

目的:探讨肝移植术后胆系造影的临床价值。方法:回顾性总结了20例肝移植患者的胆系造影表现及临床资料。并简要分析了异常影像与胆系合并症的关系。结果:5例肝内胆管系统呈痉挛、枯枝状,6例肝内胆管壁不规则,小斑片状,管腔粗细不均,2例胆管吻合口区域狭窄。1例胆管吻合口瘘。6例显示正常。结论:肝移植术后常规胆系造影检查十分重要,对了解胆道通畅情况及胆管系统合并症有很大临床应用价值。     

原位肝移植术后胆道狭窄的介入治疗

目的:探讨经T型管及其窦道和经皮肝穿刺胆道引流治疗原位肝移植术后胆道狭窄的可行性及其疗效.方法:对252例原位肝移植术后出现胆道狭窄的26例患者分别行胆道气囊扩张术、胆道引流术和胆道支架置入术.结果:3例胆道狭窄合并胆瘘患者和3例单纯吻合口狭窄患者,经气囊扩张术和胆道引流后痊愈.6例肝内外胆管多发狭窄患者,气囊反复扩张胆道狭窄段后,5例狭窄纠正而获得痊愈;1例气囊扩张治疗后出现肝内血肿,再次行肝移植.12例肝内外胆管多发狭窄合并胆泥的患者,经反复球囊导管扩张后,10例狭窄明显减轻,黄疸缓解;1例置入胆道支架,后因支架管阻塞而再次肝移植;1例治疗后狭窄仍存在,黄疸无缓解而再次肝移植.2例T型管引流口段狭窄行经皮肝穿刺胆道引流术后,狭窄明显减轻,黄疸缓解.结论:经T型管及其窦道和经皮肝穿刺胆道引流是治疗原位肝移植术后胆道狭窄的良好方法.     

Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images

PURPOSE: To determine the accuracy of magnetic resonance (MR) cholangiography for demonstration of the biliary tract and detection of biliary complications in patients who have undergone orthotopic liver transplantation. MATERIALS AND METHODS: Breath-hold half-Fourier rapid acquisition with relaxation enhancement MR cholangiography was performed in 25 patients who had undergone orthotopic liver transplantation. MR cholangiograms were prospectively and independently interpreted by two radiologists for depiction of the biliary tract and ductal anastomosis and for complications (eg, biliary dilatation, stricture, stones). MR cholangiographic findings were correlated with findings from direct cholangiography (n = 24) and surgery (n = 1). RESULTS: MR cholangiography completely demonstrated first-order intrahepatic bile ducts in 23 (92%) patients, the donor extrahepatic bile duct in 25 (100%), the recipient extrahepatic bile duct in 17 of 18 (94%), and the anastomosis in 24 (96%). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MR cholangiography for detection of biliary dilatation and stricture were each 100%. Complete interobserver agreement occurred in the detection of biliary dilatation and stricture. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MR cholangiography for detection of stones were 100% for one radiologist and 86%, 100%, 96%, 100%, and 95%, respectively, for the other. Both radiologists agreed on the diagnosis of bile duct stones in six of seven cases (kappa = 0.90). CONCLUSION: MR cholangiography enables accurate depiction of the biliary tract and detection of biliary complications in patients with an orthotopic liver transplant.     

肝移植术后血管与胆管并发症介入治疗初探

目的：评价血管造影和胆管造影诊治肝移植术后血管及胆管并发症的价值。方法：46例原位肝移植术后B超提示血流速度不畅或频谱异常，下肢水肿或黄疸的患者16例，进行腹腔动脉造影10例次，下腔静脉造影并球囊扩张或支架置入6例次，经皮肝穿刺门静脉造影并支架置入2例次，经皮肝穿刺胆管造影并引流4例次。结果：肝动脉血栓形成2例，1例经溶栓治疗后部分开通；肝动脉狭窄4例，1例球囊扩张后狭窄减轻；所有下腔静脉和门静脉阻塞或狭窄行球囊扩张及置放支撑架后临床症状好转，4例胆管狭窄和吻合口瘘者行经皮肝穿刺胆管造影引流（PTCD）治疗后黄疸减轻。结论；对肝移植术后出现的血管和胆管并发症，血管造影和胆管造影不仅可明确诊断，而且能同时工取得较好的近期疗效。     

The usefulness of hepatobiliary scintigraphy in the diagnosis of complications after adult-to-adult living donor liver transplantation

Living donor liver transplantation has become an accepted procedure to overcome the shortage of adult donor organs. The aim of this study was to evaluate the usefulness of hepatobiliary scintigraphy in the diagnosis of complications after adult-to-adult living donor liver transplantation. We analysed 82 hepatobiliary scintigraphy studies performed using technetium-99m DISIDA in 60 adult patients (44 males, 16 females) who had been transplanted with a living donor's hepatic lobe (right lobe, 32; left lobe, 28). Indications for hepatobiliary scintigraphy were abnormal symptoms and/or liver function tests ( n=54) or suspected bile leak or biloma ( n=28). Median interval between transplantation and scintigraphy was 69 days (9 days to 23 months). Scintigraphic findings were classified into hepatic parenchymal dysfunction, total biliary obstruction, segmental biliary obstruction, bile leak and normal graft. Scintigraphic findings were confirmed by liver biopsy in 17 cases, and by radiological and clinical follow-up in 65 cases. There were 29 events relating to biliary complications (six total biliary obstructions, eight segmental biliary obstructions and 15 bile leaks) and 19 relating to non-biliary complications (15 cases of rejection, two of infection and two of vascular compromise) in 38 patients. Hepatobiliary scintigraphy provided the correct diagnosis in all eight segmental and five of six total biliary obstructions, and in all 15 cases of bile leak. Of the 19 non-biliary complications, 16 showed parenchymal dysfunction regardless of the aetiology and three showed total biliary obstruction on scintigraphy. All but three of 34 normally functioning grafts were normal on scintigraphy. The diagnostic sensitivity and specificity of scintigraphy for biliary obstruction in the 54 patients with abnormal symptoms or liver function tests were 93% (100% for segmental, 83% for total) and 88% (35/40), respectively. The sensitivity and specificity were each 100% (15/15, 13/13) for bile leak in the 28 patients with suspected bile leak or biloma. Hepatobiliary scintigraphy is an accurate diagnostic modality in the evaluation of biliary complications after adult-to-adult living donor liver transplantation, although it has limitations as a means of differential diagnosis of non-biliary complications.     

MR cholangiography in biliary complications after liver transplantation in children

PURPOSE: To evaluate the role of MR Cholangiography in a pediatric population with biliary complications after liver transplantation and particularly with anastomotic stenosis. PATIENTS AND METHODS: Ten MR cholangiography studies were performed in 10 children with liver transplant who were suspected of having biliary complications between December 1996 and April 1998. The findings on MR were correlated with the results from liver biopsy, liver ultrasound, liver function tests and with clinical information when available. RESULTS: MR cholangiography identified 9 children with biliary tree dilatation, 4 with anastomotic stenosis, 5 with multiple bile ducts stenosis, 2 with stones in the intra-hepatic biliary tree and 2 with abnormalities suspicious for acute cholangitis. Three of 4 anastomotic stenoses were confirmed and treated by percutaneous cholangiography. There was no correlation between the different exams in 6 children but MR cholangiography confirmed the final diagnosis. CONCLUSION: In children with liver transplantation, MR cholangiography may be useful to evaluate and to confirm a diagnosis of bile duct complications and it is helpful in the absence of correlation between liver biopsy, ultrasound and liver function test.     

Percutaneous Transhepatic Biliary Drainage in the Management of Postsurgical Biliary Leaks in Patients with Nondilated Intrahepatic Bile Ducts

Purpose To assess the feasibility of percutaneous transhepatic biliary drainage (PTBD) for the treatment of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts, its efficacy in restoring the integrity of bile ducts, and technical procedures to reduce morbidity. Methods Seventeen patients out of 936 undergoing PTBD over a 20-year period had a noncholestatic liver and were retrospectively reviewed. All patients underwent surgery for cancer and suffered a postsurgical biliary leak of 345 ml/day on average; 71% were in poor condition and required permanent nutritional support. An endoscopic approach failed or was excluded due to inaccessibility of the bile ducts. Results Established biliary leaks and site of origin were diagnosed an average of 21 days (range 1–90 days) after surgery. In all cases percutaneous access to the biliary tree was achieved. An external (preleakage) drain was applied in 7 cases, 9 patients had an external–internal fistula bridging catheter, and 1 patient had a percutaneous hepatogastrostomy. Fistulas healed in an average of 31 days (range 3–118 days ) in 15 of 17 patients (88%) following PTBD. No major complications occurred after drainage. Post-PTBD cholangitis was observed in 6 of 17 patients (35%) and was related to biliary sludge formation occurring mostly when drainage lasted >30 days and was of the external–internal type. Median patient survival was 17.7 months and in all cases the repaired biliary leaks remained healed. Conclusions PTBD is a feasible, effective, and safe procedure for the treatment of postsurgical biliary leaks. It is therefore a reliable alternative to surgical repair, which entails longer hospitalization and higher costs.