目的评价血管造影和胆道造影诊治肝移植术后血管及胆道并发症的价值.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,经皮肝穿门静脉造影并支架置入2例次,经皮肝穿胆道造影并引流4例次.结果肝动脉血栓形成2例,1例经性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例胆道狭窄和吻合口瘘者行经皮肝穿胆道造影引流(PTCD)治疗后黄疸减轻.结论对肝移植术后出现的血管和胆道并发症,血管造影和胆道造影不仅可明确诊断,而且能同时进行处理并取得较好的近期疗效.%Objective To evaluate the value of angiography and cholangiography on the diagnosis and interventional treatment of vascular and biliary complications after liver transplantation. Methods Sixteen of 46 patients (15 men and 1 woman, 17-60 years old) after orthotopic liver transplantation received angiography due to abnormal ultrasonography or edema of lower limbs, or cholangiography due to progressing jaundice. Percutaneous transluminal angioplasty or drainage was performed in some patients.Results Fifteen patients experienced vascular complications and 4 patients had biliary complications. Three of them appeared to have both vascular and biliary complications. Hepatic artery complications were the most common complications (9/16), including hepatic artery thrombosis or stenosis (6/9), bleeding (2/9) and hepatic artery-dissecting aneurysm (1/9). One patient with hepatic artery thrombosis received transcatheter thrombolysis and two patients with bleeding received coil embolization. Inferior vena cava and portal vein stenosis were observed in 6 and 2 patients, respectively. After balloon angioplasty or stent placement, clinical symptoms were alleviated. Biliary complications, including biliary stricture and anastomotic bile leak, occurred in 4 patients. Jaundice decreased after percutaneous transhepatic cholangiography and drainage. Conclusions Besides diagnosis, interventional methods include mini-invasive treatment for patients with vascular and biliary complications after liver transplantation. Balloon angiography and stent placement for venous stenosis are useful procedure for the treatment of these problems.
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