超声对移植肝肝门部淋巴结反应性增生的诊断和随访价值

The diagnostic and follow up value of unltrasonography on hepatic hilar lymph node reactive hyperplasia after liver transplantation

目的探讨超声对移植肝肝门部淋巴结反应性增生的诊断和随访价值。方法回顾性分析2006年2月至2016年2月在浙江大学医学院附属第一医院肝移植中心行肝移植术并接受超声常规随访1年以上1 019例受者的超声资料,分析和总结87例符合移植后肝门部淋巴结反应性增生受者的临床资料和超声影像特征。结果肝移植术后1年,肝门部淋巴结反应性增生发生率为8.54%(87/1 019),超声发现淋巴结肿大时间中位数为移植术后55 d(7~270 d);肝门部淋巴结增大单发57例,多发30例;淋巴结平均长径(24.6±6.2)mm,横径(17.4±2.9)mm;内部回声均匀,彩色血流信号不丰富。伴发门静脉受压2例,轻、中度狭窄;包绕肝门血管生长并伴有肝内胆管轻度扩张3例。肝门部肿大淋巴结平均消失或缩小时间为(82±57)d。结论对肝门部淋巴结反应性增生超声特征的认识可以减少一部分移植肝穿刺活检。超声可以作为肝移植术后辅助诊断和监测肝门部淋巴结反应性增生的有效影像手段。

Objective To investigate the diagnostic and follow up value of unltrasonography on hepatic hilar lymph node reactive hyperplasia after liver transplantation. Methods The ultrasonographic data of 1019 liver transplant recipients who got liver transplantation in the First Affiliated Hospital of Zhejiang University during February 2006 and February 2016 were retrospectively analyzed,all therecipients were followed up more than 1 year,among which,the clinical data and ultrasonographic features of 87 recipients whose lymph node in hepatic hilar enlarged were analyzed further. Results The incidence rate of hilar lymph node reactive hyperplasia was 8. 54%（87/1 019）1 year after transplantation. The enlarged lymph node in hepatic hilar were detected 7 days to 270 days after transplantation by unltrasonography. Fifty-seven recipients had single hepatic hilar lymph node reactive hyperplasia and other 30 recipients had multiple hepatic hilar lymph node reactive hyperplasia;the average length of the enlarged lymph nodes was（24. 6 ± 6. 2） mm and the transverse diameter was（17. 4 ± 2. 9） mm; the internal echo of enlarged lymph nodes was homogeneous and the color doppler flow image showed little blood signal. Two recipients were accompanied with mild to moderate portal vein stenosis. Three recipients whoes blood vessels in hepatic hilus were surrounded by enlarged lymph nodes were accompanied with mild intra-hepatic bile duct dilation. The average disappearance or reduction time of enlarged lymph nodes were（82 ± 57） days. Conclusions Understanding theultrasonographic and clinical features of lymph node hyperplasia in hepatic hilar can reduce most unnecessary biopsies. Unltrasonography can be used as an effective imaging tool for evaluating and monitoring hepatic hilar lymph node reactive hyperplasia after liver transplantation.