CAJ | 학술논문

目的分析总结肝移植术后肝动脉并发症伴侧支形成超声造影(CEUS)表现,探讨CEUS评价肝移植术后肝动脉并发症伴侧支形成的价值.方法2004年4月至2011年12月中山大学附属第三医院肝移植中心所有肝移植术后常规超声或临床表现疑似肝动脉并发症行CEUS检查、并行数字减影血管造影(DSA)检查和(或)CT+CT血管成像(CTA)证实有及无肝动脉侧支形成患者30例.回顾性分析比较肝动脉并发症伴侧支与无侧支患者肝动脉 CEUS表现.结果30例肝移植患者中,11例CT+CTA和(或)DSA检查证实肝动脉有侧支,19例DSA检查证实肝动脉无侧支.肝动脉有侧支患者肝动脉并发症诊断时间晚于肝动脉无侧支患者[304 d(144~1917 d) vs 47 d(5~232 d), U=20,P<0.01].11例肝动脉有侧支患者均有肝动脉并发症,且以肝动脉血栓多见(9/11,81.8%);而19例肝动脉无侧支患者肝动脉并发症以肝动脉狭窄多见(15/19,78.9%),有1例患者无肝动脉并发症;肝动脉有侧支和无侧支患者肝动脉并发症类型差异有统计学意义(Fisher 精确概率法,P =0.001).肝动脉有侧支患者临床表现多平稳,但常规超声检查发现多数病例胆管异常(10/11).肝动脉侧支CEUS表现有一定特征:(1)肝固有动脉多不能显示(10/11);(2)肝门部多条细小迂曲的侧支动脉聚集,呈网状(5/11)或片状增强(6/11),伴细条状增强(2/11).肝动脉无侧支患者除了3例肝动脉血栓外,肝固有动脉均可见显示,肝门部均未见除肝动脉以外的其他动脉.结论肝移植术后肝动脉并发症伴侧支形成CEUS表现具有一定特点,CEUS有可能成为诊断肝移植术后肝动脉并发症伴侧支形成的新方法.
목적분석총결간이식술후간동맥병발증반측지형성초성조영(CEUS)표현,탐토CEUS평개간이식술후간동맥병발증반측지형성적개치.방법2004년4월지2011년12월중산대학부속제삼의원간이식중심소유간이식술후상규초성혹림상표현의사간동맥병발증행CEUS검사、병행수자감영혈관조영(DSA)검사화(혹)CT+CT혈관성상(CTA)증실유급무간동맥측지형성환자30례.회고성분석비교간동맥병발증반측지여무측지환자간동맥 CEUS표현.결과30례간이식환자중,11례CT+CTA화(혹)DSA검사증실간동맥유측지,19례DSA검사증실간동맥무측지.간동맥유측지환자간동맥병발증진단시간만우간동맥무측지환자[304 d(144~1917 d) vs 47 d(5~232 d), U=20,P<0.01].11례간동맥유측지환자균유간동맥병발증,차이간동맥혈전다견(9/11,81.8%);이19례간동맥무측지환자간동맥병발증이간동맥협착다견(15/19,78.9%),유1례환자무간동맥병발증;간동맥유측지화무측지환자간동맥병발증류형차이유통계학의의(Fisher 정학개솔법,P =0.001).간동맥유측지환자림상표현다평은,단상규초성검사발현다수병례담관이상(10/11).간동맥측지CEUS표현유일정특정:(1)간고유동맥다불능현시(10/11);(2)간문부다조세소우곡적측지동맥취집,정망상(5/11)혹편상증강(6/11),반세조상증강(2/11).간동맥무측지환자제료3례간동맥혈전외,간고유동맥균가견현시,간문부균미견제간동맥이외적기타동맥.결론간이식술후간동맥병발증반측지형성CEUS표현구유일정특점,CEUS유가능성위진단간이식술후간동맥병발증반측지형성적신방법.
@@@@Objective To summarize the contrast-enhanced ultrasonographic (CEUS) features of hepatic artery complication with collateral transformation after liver transplantation and to explore the diagnostic value of CEUS for collateral transformation of hepatic artery .Methods All 30 post-orthotopic liver transplantation patients suspected hepatic artery complication by color Doppler flow imaging or clinical manifestation were performed CEUS ,digital subtraction angiography ( DSA) and/or computed tomography combining computed tomography angiography (CT+CTA) at liver transplantation center of the Third Affiliated Hospital of Sun Yat-sen University between April 2004 and December 2011.Hepatic artery CEUS features of patients with collateral transformation of hepatic artery and patients without collateral transformation of hepatic artery were retrospectively compared.Results There were 30 post-orthotopic liver transplantation patients , including 11 patients with collateral transformation of hepatic artery confirmed by CT +CTA or DSA and 19 patients without collateral transformation of hepatic artery confirmed by DSA .The diagnostic time of hepatic artery complication in patients with collateral transformation of hepatic artery was significantly later than that of patients without collateral transformation of hepatic artery (144-1917 d,median 304 d vs 5-232 d,median 47 d,U=20,P<0.01).All 11 patients with collateral transformation of hepatic artery had hepatic artery complication and most of them were hepatic artery thrombosis (HAT) patients(9/11,81.8%);however,most of patients without collateral transformation of hepatic artery were hepatic artery stenosis ( HAS) patients (15/19,78.9%) and one of them had normal hepatic artery .The distribution of hepatic artery complication types between two groups was significantly different (Fisher′s exact test,P=0.001).Patients with collateral transformation of hepatic artery hadn not evident clinical symptoms , but most of them showed bile duct abnormality(10/11) in conventional ultrosonography .Hepatic artery CEUS features of patients with collateral transformation of hepatic artery had particular features as follows:(1)Proper hepatic artery in most patients could not be displayed(10/11).(2)Small,tortuous arteries gathered as reticulate (5/11) or patchy(6/11) pattern,accompanied with stripe enhanced pattern (2/11) in porta hepatis.The proper hepatic arteries were displayed and no other arteries at porta hepatic were displayed in all patients without collateral transformation of hepatic artery except 3 HAT patients.Conclusion Collateral transformation of hepatic artery in patients with hepatic artery complication after liver transplantation had some particular features in CEUS which may be a new method to diagnose collateral transformation of hepatic artery .