MRCP诊断肝脏移植术后胆管狭窄

MRCP diagnosis of biliary stricture after liver transplantation

目的:探讨MRCR探查肝脏移植术后胆管狭窄的可行性。方法:19例原位肝脏移植术后3～10月临床怀疑胆管狭窄病人行MRCP检查,其中16例在1周内行ERCP检查确诊,3例经临床和实验室检查随访2月作出最后诊断。MRCP征象与ERCP、临床最终结果对照分析了解MRCP诊断胆管狭窄的价值及局限性。结果:15例病人确诊为胆管狭窄并植入支架,包括1例MRCP正常而ERCP考虑吻合口狭窄,随访半月症状加重也实施支架植入术,其中吻合口狭窄2例,非吻合口狭窄13例。1例供受体胆管不称误诊为吻合口狭窄。3例胆管无狭窄病人诊断为胆管炎。MRCP诊断胆管狭窄敏感性为93%,特异性为75%。本组资料显示碱性磷酸酶和γ-谷氨酰酶升高常提示胆管狭窄。结论:MRCP能够正确诊断肝脏移植术后胆管狭窄,但与ERCP相比由于分辨率较低病变细节不够清晰,往往会夸大狭窄程度,我们认为动态观察碱性磷酸酶和γ-谷氨酰酶、MRCP能够早期作出诊断。

Objective： To discuss the feasibility of MRCP in the diagnosis of biliary stricture after liver transplantation. Methods： MRCP was performed in 19 patients with suspected biliary stricture in 3 to 10 months after orthotopic liver transplantation （OLT）. Diagnostic confirmation was obtained with endoscopic retrograde cholangiopancreatography （ERCP） during one week after MRCP（n=16）, two months＇ clinical and laboratory follow-up（n=3）. Combined with ERCP and clinical follow-up, the value and limitation of MRCP were analysed. Results： Fifteen patients were diagnosed as biliary stircture and had the stent implantation, in one case of whom had normal findings on MRCP and stent was implanted 15 days later because of the aggravation of the biliary obstruction. Two were anastomotic stricture（AS） and 13 nonanastomotic stircture（NAS）. One case with donor-to-recipient common bile duct disproportion was misdiagnosed as anastomotic stricture. Three cases were confirmed to have cholangitis finally. For diagnosis of biliary stricture, MRCP had 93% sensitivity, 75% specificity. Our study showed that the bilary stricture were usually accompanied by the elevation of Alkaline phosphatase and Gamma glutamyl. Conclusion： Compared with ERCP, MRCP can show the biliary stricture correctly after OLT, but cannot discribe the lesions in detail due to the lower resolution and usually exaggerates the extent of stricture. Combined with the monitoring the level of Alkaline phosphatase and Gamma glutamyl, MRCP will provide the diagnosis early.