肝癌患者活体肝移植术后并发症的MDCT和MRI评价

Postoperative Complications after Living Donor Liver Transplantation for Patients with Hepatocellular Carcinoma:Evaluation by Multi-Detector Row Spiral CT and Magnetic Resonance Imaging

目的分析肝癌患者行活体肝移植(living donor liver transplantation,LDLT)术后并发症的多层螺旋CT(multi-detector rowspiral CT,MDCT)和磁共振成像(magnetic resonance imaging,MRI)表现。方法纳入2008年1月至2010年6月期间在四川大学华西医院接受LDLT的肝癌患者20例共计39份影像资料,由两位放射科医师回顾性分析图像,观察并发症的种类及影像表现。结果 20例患者均出现程度不同的并发症,包括:常规并发症20例,其中腹腔积液14例,气腹2例,腹膜及其形成结构(大网膜和肠系膜)肿胀1例,腹壁软组织肿胀2例,胸腔积液9例,心包积液2例;肝血管并发症有8例,其中肝动脉并发症3例,门静脉并发症5例;胆道并发症有7例,其中吻合口狭窄6例,胆汁漏1例;移植肝实质并发症有12例,肝内淋巴淤滞11例,肝实质梗塞3例,肝实质感染2例;肿瘤复发和(或)转移6例,出现肝内肿瘤复发5例,3例腹腔脏器转移,2例肺部转移。结论 MDCT和MRI对肝癌患者LDLT术后并发症的诊断有重要价值。

Objective To investigate the radiological appearances of postoperative complications after living donor liver transplantation for patients with hepatocellular carcinoma under multi-detector row spiral computed tomography （MDCT） and magnetic resonance imaging （MRI） examination. Methods Thirty-nine imaging data in 20 patients with hepatocellular carcinoma after living donor liver transplantation from January 2008 to June 2010 in the Wesl China Hospital were included and analyzed by two radiologists respectively. The relations between the types of complications and radiological appearances were especially recorded. Results All the cases experienced complications to different extent. Common surgical complications occured in 20 cases, including pertitoneal fluid col- lection （14 cases）, pneumoperitoneum （2 cases）, swelling of peritoneum, omentum, and mesentery （1 case）, ab- dominal wall swelling （2 cases）, pleural effusion （9 cases）, and pericardial fluid collection （2 cases）. Hepatic vas- cular complications involved hepatic artery in 3 cases, portal vein in 5 cases. Biliary complications presented in 7 ea- ses, including anastomotic stenosis of biliary duct （6 cases） and bile leak （1 case）. Graft parenchymal complications included intrahepatic lymph retention （11 cases）, infarction （3 cases）, and infection （2 cases）. Intrahepatic recur-rence in 5 cases, intraperitoneal me[astasis in 3 csses and pulmonary metastasis in 2 cases. Conclusion MDCT and MRI have important diagnostio values for postoperative complications after living donor liver transplantation for pa- tients with hepatocelluter carcinoma,