CAJ | 학술논문

目的运用320排CT灌注成像技术(CTP)初步了解肝移植术后缺血性胆道病变(ITBL)的肝脏血流灌注特征.方法中山大学附属第三医院自2010年4月至2011年4月11例肝移植术后经PTCD或ERCP确诊为ITBL患者和7例移植术后随访正常患者,分别接受320排CT血管成像(CTA)及CTP检查,两种检查相距5～ 10 min.其中4/11例ITBL患者接受移植肝穿刺活检.测量上述患者肝动脉灌注量(HAP)、门静脉灌注量(PVP)、全肝灌注量(TLP)及肝动脉灌注指数(HPI),通过比较两组间灌注参数差异,分析ITBL患者的肝脏血流灌注特征.结果 (1) 11例ITBL 患者中CTA检查证实无血管并发症3例,单纯性肝动脉狭窄(HAS)1例,HAS合并周围型肝动脉-门静脉瘘(APS)1例,HAS合并门静脉狭窄(PVS)/肝右静脉狭窄(RHVS)2例,单纯性APS 1例,单纯性PVS 2例,门静脉血栓(PVT)并PV海绵样变1例.4/11例接受移植肝活检中2例证实为轻度急性排斥反应,2例证实为移植胆道阻塞伴有上行性胆道感染.(2)ITBL组与对照组的HAP,(66±38)ml·min-1·(100 ml)-1比(40±8) ml·min-1·(100 ml)-1,P=0.049; PVP,(128 ±35) ml·min-1· (100 ml)-1比(163 ±21) ml·min-1· (100 ml)-1,P =0.031;TLP,(194 ±58) ml·min-1· ( 100 ml)-1比(203±19) ml· min-1· (100 ml)-1,P=0.705;HPI,34％±14％比21％±4％,P=0.009.两组间HAP、PVP及HPI的差异均有统计学意义(均P＜0.05),TLP差异无统计学意义(P＞0.05).结论运用320排CTP技术进行全肝四维灌注分析,能够全面反映移植肝组织的血流动力学状态,无创性评价ITBL患者各种移植肝血流灌注异常.当HAP增高,PVP减低,HPI增高时,亦需注意ITBL发生的可能.
목적 운용320배CT관주성상기술(CTP)초보료해간이식술후결혈성담도병변(ITBL)적간장혈류관주특정.방법 중산대학부속제삼의원자2010년4월지2011년4월11례간이식술후경PTCD혹ERCP학진위ITBL환자화7례이식술후수방정상환자,분별접수320배CT혈관성상(CTA)급CTP검사,량충검사상거5～ 10 min.기중4/11례ITBL환자접수이식간천자활검.측량상술환자간동맥관주량(HAP)、문정맥관주량(PVP)、전간관주량(TLP)급간동맥관주지수(HPI),통과비교량조간관주삼수차이,분석ITBL환자적간장혈류관주특정.결과 (1) 11례ITBL 환자중CTA검사증실무혈관병발증3례,단순성간동맥협착(HAS)1례,HAS합병주위형간동맥-문정맥루(APS)1례,HAS합병문정맥협착(PVS)/간우정맥협착(RHVS)2례,단순성APS 1례,단순성PVS 2례,문정맥혈전(PVT)병PV해면양변1례.4/11례접수이식간활검중2예증실위경도급성배척반응,2예증실위이식담도조새반유상행성담도감염.(2)ITBL조여대조조적HAP,(66±38)ml·min-1·(100 ml)-1비(40±8) ml·min-1·(100 ml)-1,P=0.049; PVP,(128 ±35) ml·min-1· (100 ml)-1비(163 ±21) ml·min-1· (100 ml)-1,P =0.031;TLP,(194 ±58) ml·min-1· ( 100 ml)-1비(203±19) ml· min-1· (100 ml)-1,P=0.705;HPI,34％±14％비21％±4％,P=0.009.량조간HAP、PVP급HPI적차이균유통계학의의(균P＜0.05),TLP차이무통계학의의(P＞0.05).결론 운용320배CTP기술진행전간사유관주분석,능구전면반영이식간조직적혈류동역학상태,무창성평개ITBL환자각충이식간혈류관주이상.당HAP증고,PVP감저,HPI증고시,역수주의ITBL발생적가능.
Objective To investigate the value of 320-slics CT perfusion (CTP) imaging in the study of hepatic hemodynamic characters in ischmic-type biliary lesions (ITBL) after liver transplantation.Methods A total of 11 ITBL patients received 320-slice CT angiography (CTA) and CTP after liver transplantation scheduled at 5 - 10 min away.Four patients underwent liver biopsy While 7 patients with normal liver after transplantation were selected as the control group.The parameters of hepatic artery perfusion (HAP),portal vein perfusion (PVP),total hepatic perfusion (TLP) and hepatic arterial perfusion index (HPI) were measured and compared for all patients.And the blood perfusion characters of liver with ITBL after transplantation were analyzed.Results ( 1 ) In 11 ITBL patients,3 patients had no vascular complications on CTA,1 with simple hepatic artery stenosis (HAS),1 with HAS and arterioportal shunt (APS),2 with HAS and portal vein stenosis/right hepatic vein stenosis (PVS/RHVS),1 with simple APS,2 with simple PVS and 1 with portal vein thrombosis and cavernous transformation of portal vein ( PVT and CTPV).And 4/11 patients underwent liver biopsy,2 in which confirmed mild acute rejection and 2 confirmed biliary obstruction associated with ascending biliary infection.(2) HAP of the ITBL and control groups were (66±38) and (40±8) ml· min-1 · (100 ml)-1,PVP (128±35) and (163±21) ml · min-1 · (100 ml)-1,TLP (194±58) and (203 ±19) ml · min-1 · (100 ml)-1,HPI 34％ ± 14％ and 21％ ± 4％ respectively.The differences in the value of HAP,PVP and HPI between the groups were statistically significant ( P ＜ 0.05 ) excluding TLP.Conclusion Various liver perfusion abnormalities of ITBL may be evaluated objectively by CTP.ITBL might occured when HAP and HPI increased with a decreased of PVP.