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

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。

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

Objective To investigate the ultrasonograms of biliary sludge and its relationship with the prognosis of patients after liver transplantation. Methods Uhrasonograms 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 uhrasonograms of biliary sludge between different prognosis groups. Biliary sludge combined with ischemic-type biliary lesions suggests a poor prognosis, which may needmore active interventional treatments.