CAJ | 학술논문

目的探讨肝移植后不同类型胆道狭窄的造影特点,并探讨其与病因的联系.方法 46例肝移植受者,术后发生黄疸,行经皮经肝胆道造影(PTC)及经皮肝穿刺组织病理学检查证实诊断；1例行肝动脉造影检查,45例行多层CT检查及肝动脉重建.回顾性分析其胆道造影表现,对胆道狭窄类型进行分类,利用Fisher确切概率法分析不同类型胆道狭窄患者的肝内、外胆道形态学改变的异同点,并结合发病机制加以阐述.结果 PTC证实吻合口狭窄(ABS)为21例,非吻合口狭窄(NBS)为25例,其中NBS伴肝动脉栓塞(HAT)13例,不伴HAT 12例.PTC示肝门区胆管狭窄患者共26例,NBS患者(发生率92.0％)发生肝门区胆管狭窄明显多于ABS患者(发生率14.3％,P＜0.05).肝内胆管狭窄患者共31例,NBS患者(发生率100.0％)发生肝内胆管狭窄明显多于ABS患者(发生率28.6％,P＜0.05).肝内胆管扩张患者共33例,不合并HAT的NBS患者(发生率16.7％)发生肝内胆管扩张明显少于ABS患者(发生率100.0％)及合并HAT的NBS患者(发生率76.9％,P＜0.05).肝外胆管扩张患者共21例,ABS患者(发生率85.7％)发生肝外胆管扩张明显多于NBS患者(发生率12.0％,P＜0.05).肝内胆管狭窄、扩张同时出现的患者共18例,ABS患者肝内胆管扩张较多见(发生率100.0％),不合并HAT的NBS患者以肝内胆管狭窄多见(发生率100.0％),但合并HAT的NBS患者(发生率76.9％)出现肝内胆管狭窄并扩张明显多于ABS患者(28.6％)及不合并HAT的NBS患者(发生率16.7％,P＜0.05).46例经皮肝穿刺组织病理学检查表现符合胆管狭窄的诊断.结论肝移植后ABS患者、合并及不合并HAT的NBS患者的造影表现有不同的特点,其胆管狭窄及扩张部位不同.
목적 탐토간이식후불동류형담도협착적조영특점,병탐토기여병인적련계.방법 46례간이식수자,술후발생황달,행경피경간담도조영(PTC)급경피간천자조직병이학검사증실진단；1례행간동맥조영검사,45례행다층CT검사급간동맥중건.회고성분석기담도조영표현,대담도협착류형진행분류,이용Fisher학절개솔법분석불동류형담도협착환자적간내、외담도형태학개변적이동점,병결합발병궤제가이천술.결과 PTC증실문합구협착(ABS)위21례,비문합구협착(NBS)위25례,기중NBS반간동맥전새(HAT)13례,불반HAT 12례.PTC시간문구담관협착환자공26례,NBS환자(발생솔92.0％)발생간문구담관협착명현다우ABS환자(발생솔14.3％,P＜0.05).간내담관협착환자공31례,NBS환자(발생솔100.0％)발생간내담관협착명현다우ABS환자(발생솔28.6％,P＜0.05).간내담관확장환자공33례,불합병HAT적NBS환자(발생솔16.7％)발생간내담관확장명현소우ABS환자(발생솔100.0％)급합병HAT적NBS환자(발생솔76.9％,P＜0.05).간외담관확장환자공21례,ABS환자(발생솔85.7％)발생간외담관확장명현다우NBS환자(발생솔12.0％,P＜0.05).간내담관협착、확장동시출현적환자공18례,ABS환자간내담관확장교다견(발생솔100.0％),불합병HAT적NBS환자이간내담관협착다견(발생솔100.0％),단합병HAT적NBS환자(발생솔76.9％)출현간내담관협착병확장명현다우ABS환자(28.6％)급불합병HAT적NBS환자(발생솔16.7％,P＜0.05).46례경피간천자조직병이학검사표현부합담관협착적진단.결론 간이식후ABS환자、합병급불합병HAT적NBS환자적조영표현유불동적특점,기담관협착급확장부위불동.
Objective To investigate the imaging characteristics of different biliary strictures after liver transplantation and their relationship with causes. Methods Forty-six patients with jaundice and biliary stricture were enrolled in this study.The diagnosis was confirmed by percutaneous transhepatic cholangiography (PTC).All the patients had hepatic arteriography with DSA or CTA and underwent liver biopsy.Their imaging characteristics were analyzed and the related statistic analysis was conducted.Results Anastomosis biliary stricture (ABS) was demonstrated in 21 cases,and non-anastomosis biliary stricture (NBS) with hepatic artery thrombosis (HAT) occurred in 13 cases,and there were 12 cases of NBS without HAT.PTC examination confirmed there were 26 cases of biliary stricture at hepatic hilum,and the incidence of biliary stricture in NBS group was significantly higher than that in ABS group (92％ vs.14.35％,P＜0.05).There were 31 cases of intrahepatic bile duct stricture,and the incidence in NBS group was significantly higher than that in ABS group ( 100％ vs.28.6％,P＜0.05).There were 33 cases of dilatation of intrahepatic bile duct,and the incidence in NBS without HAT group was significantly lower than that in ABS group and NBS with HAT group (16.7％,100％ and 76.9％ respectively) (P＜0.05).There were 21 cases of extrahepatic biliary dilatation,and the incidence in ABS group was significantly higher than that in NBS group (85.7％ vs. 12％,P＜0.05). There were 18 cases of stricture and dilatation in intrahepatic bile duct,and the incidence in NBS with HAT group was significantly higher than that in ABS group and NBS without HAT group (76.9％,28.6％ and 16.7％ respectively,P＜0.05).The results of the liver biopsy were accorded with the diagnosis of biliary stricture,Conclusion The different biliary strictures carry different imaging characteristics,including location of biliary stricture,and location and type of secondary biliary dilatation.