肝移植术后胆系并发症的T管造影表现

T-tube Cholangiographic Manifestations of Biliary Complications after Orthotopic Liver Transplantation

目的 探讨肝移植术后胆系并发症的T管造影表现及其意义。资料与方法 搜集 5 2例肝移植术后T管造影病例中发生胆系并发症的患者 2 4例 ,其中男 2 0例 ,女 4例 ,年龄 2 1～ 6 4岁。所有病例均行T管造影 ,并将X线表现与肝穿刺病理所见对照。结果 并发症发生率为 4 6 .1% (2 4 / 5 2 )。T管造影表现 :(1) 9例早期胆汁淤积症 ,T管造影无胆管梗阻 ,但肝内胆树稀疏 ,分支细 ,有时呈“垂柳状”外观 ;(2 ) 10例胆总管吻合口胆瘘 ,表现为吻合口对比剂外漏 ,形成不规则状阴影 ;(3) 5例胆管吻合口狭窄 ,表现为胆总管吻合口的不规则形充盈缺损 ,对比剂经吻合口排入远段胆管困难 ;(4 ) 5例胆管内结石 /胆泥形成 ,表现为胆管内充盈缺损 ;(5 ) 6例胆管炎 ,肝内胆管细小 ,走行僵硬 ,胆管炎严重者可表现为胆管近肝门段狭窄、远段扩张的独特外观 ;(6 ) 3例肝外胆管吻合后过长 ,长度超过13cm。肝移植术后胆管并发症的患者T管造影表现可同时出现上述征象 1～ 4种。结论 T管造影可以明确肝移植术后的胆管并发症 ,对肝移植术后胆系的评价具有重要的价值 。

Objective To discuss T-tube cholangiographic manifestations of biliary complications after orthotopic liver transplantation and to evaluate their clinical significance.Materials and Methods Fifty-two patients who had received orthotopic liver transplantation and T-tube cholangiography were collected, of which biliary complication was found in 24, including 20 males and 4 females (aged 21～64). Radiographic findings were analyzed and compared with pathologic results.Results The complication incidence of biliary tract after orthotopic liver transplantation was 46.1% (24/52). The main T-tube cholangiographic signs were as follows. (1) Cholestasis at early stage (n=9, 37.5%). T-tube cholangiography showed no obstruction of biliary tract, but intra-hepatic biliary tree was sparse with weeping willow appearance. (2) Choledocho-anastomotic biliary fistula (n=10, 41.7%), presenting as irregular contrast leak shadow around anastomotic stoma. (3) Anastomotic biliary stricture (n=5, 20.8%), manifested itself as irregular filling defect of the anastomotic stoma. Evacuation of the contrast through the anastomotic stoma into the distal bile duct was difficult. (4) Choledocholithes and sandy stones (n=5, 20.8%), presenting as filling defect on T-tube cholangiography. (5) Cholangitis (n=6, 25%), being characterized by thin and stiff bile ducts, and stricture of bile duct close to porta hepatis and dilatation of distal bile ducts in severe cases. (6) Elongation of extrahepatic biliary duct (> 13 cm) after anastomotic surgery (n=3, 12.5%). One up to four biliary tract complications mentioned above could be coexisted in one patient at the same time after liver transplantation.Conclusion T-tube cholangiography can detect biliary complications after orthotopic liver transplantation and is very valuable in assessing the condition of the biliary tree, therefore, it should be used as one of the routine exams after the surgery.