CAJ | 학술논문

目的评价MSCT在诊断肝移植术后胆道并发症中的价值.方法 83例原位肝移植术后患者因临床和生化检查可疑胆道并发症行MSCT增强检查.胆道并发症的确诊依据为直接胆道造影69例、移植肝病理11例、肝管空肠吻合术3例.分析CT诊断胆道并发症的能力,计算其敏感度、特异度、准确度、刚性预测值和阴性预测值,并用x2检验比较胆管吻合口狭窄和非吻合口狭窄的CT特征.结果 83例中,62例(74.7%)证实有胆道并发症,其中胆管吻合口狭窄32例,非吻合口狭窄21例,胆管结石16例(12例合并胆管狭窄),胆总管吻合口漏5例,胆汁瘤4例(合并胆管狭窄)、胆源性肝脓肿2例(合并胆管狭窄).CT诊断胆管狭窄的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为90.6%、86.7%、89.2%、92.3%和83.9%.CT对胆管结石、胆总管吻合口漏、胆汁瘤、胆源性肝脓肿均能正确诊断,无漏诊和误诊.非吻合口狭窄表现为胆管不均匀扩张的发生率(71.4%,15/21)显著高于吻合口狭窄者(25.0%,8/32;P<0.01),而肝外胆管扩张(33.3%,7/21)和胆管均匀扩张(14.3%,3/21)的发生率均显著低于吻合口狭窄者(84.4%,27/32和68.8%,22/32;P<0.01).非吻合口狭窄肝动脉缺血的发生率(66.7%,14/21)明显高于吻合口狭窄者(15.6%,5/32;P<0.01).结论 MSCT对诊断肝移植术后胆道并发症具有重要价值,还可初步诊断胆管狭窄类型;肝动脉缺血是胆管非吻合口狭窄的重要原因.
목적 평개MSCT재진단간이식술후담도병발증중적개치.방법 83례원위간이식술후환자인림상화생화검사가의담도병발증행MSCT증강검사.담도병발증적학진의거위직접담도조영69례、이식간병리11례、간관공장문합술3례.분석CT진단담도병발증적능력,계산기민감도、특이도、준학도、강성예측치화음성예측치,병용x2검험비교담관문합구협착화비문합구협착적CT특정.결과 83례중,62례(74.7%)증실유담도병발증,기중담관문합구협착32례,비문합구협착21례,담관결석16례(12례합병담관협착),담총관문합구루5례,담즙류4례(합병담관협착)、담원성간농종2례(합병담관협착).CT진단담관협착적민감도、특이도、준학도、양성예측치、음성예측치분별위90.6%、86.7%、89.2%、92.3%화83.9%.CT대담관결석、담총관문합구루、담즙류、담원성간농종균능정학진단,무루진화오진.비문합구협착표현위담관불균균확장적발생솔(71.4%,15/21)현저고우문합구협착자(25.0%,8/32;P<0.01),이간외담관확장(33.3%,7/21)화담관균균확장(14.3%,3/21)적발생솔균현저저우문합구협착자(84.4%,27/32화68.8%,22/32;P<0.01).비문합구협착간동맥결혈적발생솔(66.7%,14/21)명현고우문합구협착자(15.6%,5/32;P<0.01).결론 MSCT대진단간이식술후담도병발증구유중요개치,환가초보진단담관협착류형;간동맥결혈시담관비문합구협착적중요원인.
Objective To evaluate multisliee CT in the diagnosis of biliary complications after liver transplantation. Methods Eighty-three consecutive patients who had undergone orthotopic liver transplantation (OLT) presented with clinical or biochemical signs of biliary complications and underwent contrast-enhancement CT examination. Three experienced radiologists, who were blinded to patient's clinical data, assessed CT images for the detection of biliary complications in consensus. Diagnostic confirmation of biliary complications was obtained with direct cholangiography in 69 patients, histologie study in 11 patients and hepatieojejunostomy in 3 patients. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT for the detection of biliary complications were calculated. In addition, CT features of anastomotie biliary stricture (ABS) were compared with those of non-anastomotie biliary stricture (NABS) using x2 test. Results A total of 62 biliary complications (74. 7% ) was eventually confirmed in the 83 patients, including ABS in 32 patients, NABS in 21 patients, biliary duct stones in 16 patients (of which 12 patients with biliary stricture), anastomotie bile leakage in 5 patients, biloma in 4 patients with biliary stricture, and biliogenic abscess in 2 patients with biliary stricture. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT for the detection of biliary stricture were 90. 6%、86. 7%、89. 2%、92. 3% and 83.9% , respectively. Other biliary complications, including biliary duct stones ( 16 cases) , anastomotic bile leak (5 cases) , biloma (4 cases), and biliogenic abscess (2 cases), were correctly diagnosed by CT; there was no false-positive or false-negative result. The incidence of irregular dilatation of bile duct was 71.4% ( 15/21 ), which was significantly higher in NABS cases than in ABS of 25.0% (8/32,P <0. 01 ) ; whereas the incidence of extrahepatie biliary dilatation was 33.3% (7/21) and regular dilatation was 14. 3% (3/21), which was significantly lower in NABS cases than in ABS of 84. 4% ( 27/32 ) and 68. 8% ( 22/32 ), respectively ( P < 0. 01 ). Of 21 patients with NABS, 66. 7% (14/21)complicated with hepatic artery stenosis or thrombosis, which was markedly more than that of NABS cases (15. 6%, 5/32,P <0. 01 ). Conclusions Multislice CT is a useful imaging procedure in the detection of biliary complications after liver transplantation, and biliary stricture can be primitively classified into ABS and NABS by CT. Hepatic artery ischemia is an important factor that causes NABS.