Diagnostic value of ultrasound for biliary complications after liver transplantation

doi:10.3969/j.issn.2095-4344.2014.05.007

Abstract

Abstract:

BACKGROUND: Biliary complications after liver transplantation can cause liver graft dysfunction. Ultrasound examination is one of important diagnostic methods of biliary complications after liver transplantation.

OBJECTIVE: To investigate the value of ultrasound in the diagnosis of biliary complications after liver transplantation.

METHODS: A total of 92 patients after liver transplantation, including 81 males, 11 females, aged 21-67 years; allogenic orthotopic liver transplantation in 90 cases, partial living liver transplantation in 2 cases. Biliary reconstruction methods were end-to-end biliary anastomosis. Routine examination after liver transplantation and color Doppler ultrasound results were retrospectively analyzed. The inspection focused on whether common bile duct and intrahepatic bile duct had biliary leakage, biliary stenosis, biliary sludge or biliary calculus. Some patients underwent puncture and drainage under ultrasonographic guidance.

RESULTS AND CONCLUSION: In all the 92 patients, 14 cases were diagnosed ultrasonically as biliary complications, including 5 cases of biliary leakage, 4 cases of biliary stenosis (2 cases of stomal stenosis and 2 cases of non-stomal stenosis), 4 cases of biliary sludge, and 1 case of biliary calculus. This study demonstrated that ultrasound characteristics could be easily recognized in liver transplantation patients with biliary complications. Ultrasound has very important clinical value in diagnosis of the biliary complications after liver transplantation.

中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程

全文链接：

Key words: liver transplantation, ultrasonography, biliary tract, gallstones, postoperative complications

CLC Number:

R318

Bo Hua-ying, Xia Dao-zi, Zhang Yu-hong. Diagnostic value of ultrasound for biliary complications after liver transplantation[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(5): 693-698.

Figures/Tables 1

2.1 参与者数量分析纳入常规超声检查的92例肝移植患者进行回顾性病例分析，其中14例临床确诊为胆道并发症(15.2%)，全部完成随访，数据无脱落。 2.2 胆道并发症的发生情况胆漏5例(5.4%)；胆道狭窄4例(4.3%)，其中吻合口狭窄2例，非吻合口狭窄2例；4例胆泥形成(4.3%)；1例胆管结石(1%)。 2.3 随访结果胆漏：5例发生胆漏。其中3例为肝外胆管胆漏，超声表现为右肝下间隙积液，其中1例肝移植后1周行剖腹探查证实并行膈下引流，2例于超声引导下穿刺引流。 2例移植肝内胆漏致胆汁瘤形成，表现为沿肝内胆管分布的带状弱回声区并逐渐液化形成胆汁瘤，经磁共振胆胰管成像证实，其中1例患者超声动态观察瘤体逐渐缩小纤维化并出现部分钙化，另1例经超声引导下穿刺置管引流症状缓解，但肝功能进行性减低随后行再次肝移植。胆道狭窄：4例患者肝移植后出现胆道狭窄，其中吻合口狭窄2例，非吻合口狭窄2例，可见狭窄段胆管壁增厚，回声增强，狭窄处管腔变窄，狭窄上方的胆管扩张，结果均经磁共振胰胆管成像或内镜逆行胰胆管造影证实。 1例胆道梗阻患者表现为肝移植1年后肝生化检查转肽酶缓慢持续升高，肝内胆管轻度扩张，经超声引导下穿刺肝组织活检证实为移植肝慢性排斥反应，后经皮穿刺肝内胆管支架置入狭窄解除。 3例胆道狭窄患者经内镜逆行球囊扩张并支架治疗解除胆道狭窄。胆泥形成或胆道结石：4例胆泥形成患者，超声表现为扩张胆管内中高回声，后方不伴声影。 1例胆管结石超声表现为胆管左右支汇合部强回声，后方伴声影。 2.4 典型病例病例1：男，47岁，肝移植后3个月，皮肤黄疸并发热，超声发现肝内胆管扩张，胆管壁毛躁，胆管内多发胆泥形成(图1)。病例2：男，46岁，肝移植后10个月，皮肤黄疸，肝功能异常，超声检查发现肝内胆管局部狭窄并相邻胆管轻度扩张，经磁共振胰胆管成像及内镜逆行胰胆管造影证实为肝内胆管局部狭窄，经内镜胆管支架置入后黄疸逐渐消退，肝功能恢复正常，复查超声可见肝内胆管内支架回声(图2)。病例3：男，46岁，肝移植后2 d彩色多普勒超声检查未探及肝动脉血流信号，后经肝动脉造影证实为肝动脉栓塞；1周后肝内出现多发胆汁瘤，经积极临床治疗及肝内胆汁瘤的超声引导下穿刺引流肝功能未见好转，行二次肝移植。 2.5 不良事件 1例患者肝移植后发生肝动脉栓塞，经肝动脉造影证实，1周后肝内出现多发胆汁瘤，行二次肝移植治疗。"

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