人体原位肝脏移植术后胆道与血管并发症的放射介入治疗

目的 评估放射介入治疗在人体原位肝脏移植病人术后胆道与血管并发症中的应用价值。方法 回顾性分析自1999年1月至2001年4月我院连续实施的48例人体原位肝脏移植的临床资料，总结放射介入技术治疗术后胆道与血管并发症的实施体会。结果 术后经T管胆道造影术及核磁共振胆胰管成像（MRCP）证实，3例病人存在胆道狭窄，其中2例为肝门部胆管与肝总管狭窄，1例为吻合口处胆管狭窄，共实施经T管窦道选择性球囊扩张术6例次，胆道狭窄得以改善，肝功能好转。术后经彩色多普勒超声、核磁共振血管造影（MRA）及静脉造影证实，2例病人存在肝上下腔静脉狭窄与门静脉吻合口狭窄，分别实施肝上下腔静脉狭窄段球囊扩张术1例次，肝上下腔静脉内支架置入术2例次、门静脉内支架置入术1例次。放射介入治疗后，影像学检查显示血管狭窄基本消失，病人肝功能明显好转、腹水显著减少、尿量增加。5例中最长1例健康存活至今已超过19个月。结论 肝脏主后应常规联合应用胆道造影术和MRCP了解胆树全貌，彩色多普勒超声和MRA监测血管血流动力学，以尽早诊断胆道和血管并发症；及时果断采用正确的放射介入技术处理胆道与血管并发症可取得良好疗效。

Interventional radiological management of biliary and vascular complications after orthotopic liver transplantation

Objective To investigate the role of interventional radiotherapy in management of biliary and vascular complications after liver transplantation. Methods The clinical data of 48 patients receiving liver transplantation from January 1999 to April 2001 in our hospital were retrospectively analyzed. Results Postoperative T tube cholangiography and magnetic resonance cholangiopancreatography (MRCP) showed that biliary strictures occurred in 3 patients. The strictures were successfully managed by balloon catheter dilation. Doppler ultrasonography and MR angiography (MRA) revealed vascular stenoses including 2 of the inferior vena cava (IVC) and 1 of the portal vein (PV) trunk following liver transplantation in 2 of the 48 patients. One patient underwent percutaneous transluminal angioplasty (PTA) via balloon expandable endovascular stent for suprahepatic IVC stenosis of the anastomosis and endovascular stent placement for kinking PV stenosis. The other patient with kinking stenosis of suprahepatic IVC was treated via stent placement. Technical success was achieved in all 5 cases with improvement in graft function. Conclusions T tube cholangiography in combination with MRCP enables accurate depiction of the bile tree and detection of biliary complications after orthotopic liver transplantation. Routine color Doppler ultrasonography and MRA are very important for accurate detection of vascular complications. The timely and appropriate application of interventional radiological therapy is a useful procedure for treatment of biliary and vascular complications.