肝移植术后胆道并发症的多层螺旋CT诊断

Biliary complications after liver transplantation： diagnosis with multi-slice CT

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、阳性预测值和阴性预测值，并用x^2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。

Objective To evaluate muhislice 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 hepaticojejunostomy 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 anastomotic biliary stricture （ABS） were compared with those of non-anastomotic 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 billary 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 biliogenie 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 extrahepatic biliary dilatation was 33.3 % （7/21 ） and regular dilatation was l d. 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.