移植肝胆道并发症与正常胆道的超声造影增强特点比较

摘要

目的 探讨肝移植后缺血性胆道病变(ITBL)区别于正常胆道及其他胆道并发症的超声造影表现.方法 选择正常健康者18例；无并发症移植肝18例；移植肝胆道并发症36例分为2组:①非ITBL组12例,包括3例胆管吻合口狭窄、4例胆管炎、1例胆泥和4例急性排异反应；②ITBL组24例.进行肝门部胆管超声造影(CEUS)检查.2名超声医生共同分析CEUS图像,记录胆管壁、肝动脉和肝实质增强时间及不同时期增强水平,总结各组肝门部胆管壁CEUS增强特点.结果 ①增强时间:除11例ITBL和1例非ITBL并发症患者胆管壁始终无增强外,其余胆管壁的开始增强时间均早于肝实质.②增强水平:动脉期,正常健康者、无并发症移植肝、非ITBL组胆管壁主要表现为等或高增强,两两比较差异无统计学意义(P＞0.05)；ITBL与上述三组差异均有统计学意义(P＜0.05),主要表现为无或低增强.结论 动脉期胆管壁无或低增强是肝移植后ITBL区别于正常健康者、无并发症移植肝、非ITBL的主要特点,这或许可以成为诊断ITBL的CEUS诊断指标.%Objective To study the enhancement patterns of hilar bile duct wall of ischemic-type biliary lesion (ITBL) on contrast-enhanced ultrasound (CEUS).Methods Eighteen healthy subjects,18 orthotropic liver transplantation (OLT) recipients without complications,and 36 patients,which were subdivided into 2 groups according to the final diagnosis:patients with (n =24) and without (n =12)ITBL,were enrolled in this study.The patients without ITBL had anastomotic biliary stricture (n =3),cholangitis (n =4),biliary sludge (n =1),and acute rejection (n =4),respectively.The images of baseline sonography and CEUS were retrospectively analyzed in consensus by 2 readers.The enhancement time and level of hilar bile duct wall,hepatic artery and liver parenchyma were recorded.Results Hilar bile duct wall became enhancing earlier than liver parenchyma in all of 4 groups.During arterial phase,hyper-or isoenhancing bile duct walls were present in most cases in the groups of healthy subjects,OLT recipients without complications and patients without ITBL.However,non-or hypo-enhancement of hilar bile duct wall were present in 16 (66.7％) ITBL patients,which is different from the other groups (P ＜0.05).Conclusions The main features of ITBL differing from the other groups were non-or hypo-enhancement of hilar bile duct wall in arterial phase.It may be a diagnostic index to apply in detecting ITBL with CEUS.