课题背景：课题立足于国内肝病高发利用活体肝移植解决供肝匮乏的矛盾，于手术前后利用影像学手段对肝移植进行评价与随访，及时了解肝脏解剖与功能的变化，为临床治疗提供指导性意见。课题已发表系列论著6篇。

应用要点：文章将影像学与肝胆外科学相结合，提出影像学能提供详实可靠资料，及时发现病变，并进行准确定位、定性，对胆系并发症的防治有积极的指导意义，得到的结果在临床上有极高的实用价值，不仅在肝移植患者的随访中有积极意义，并能推广致胆系手术等患者的随访中，因此有广泛的临床应用前景。

重要的概念：胆泥发生的相关因素：①供肝热缺血时间过长。②供肝胆道系统冲洗不足或胆道冲洗的时间偏晚，胆汁自溶引起胆道上皮损伤。③胆道上皮因急性或慢性排斥反应，发生坏死、脱落。④术后反复发生的感染。⑤T型管过粗，引起胆汁引流不畅，易形成胆汁淤积。

摘要

背景：胆道并发症是肝移植术后最常见的并发症，影像学检查能直观地了解其形态学改变。
目的：系统分析肝移植术后胆系并发症的影像学表现，以期评估术后疗效，并对术后并发症的防治提供依据。
设计、时间及地点：于2002-01/2006-12在解放军南京军区福州总医院医学影像科完成回顾性病例分析。
对象：选择资料完整的解放军南京军区福州总医院肝胆外科34例同种异体原位肝移植术后患者，男27例，女7例，所有病例均为胆总管对端吻合。
方法：对34例肝移植术后患者CT，MRI及内镜逆行胰胆管造影的影像学表现进行回顾性分析，24例行螺旋CT检查，其中5例另行内镜逆行胰胆管造影检查，5例中2例同时行引流管造影；8例行MR及磁共振胰胆管造影检查。
主要观察指标：肝移植术后胆总管及肝内胆管有否扩张、狭窄、胆泥形成、胆管内积气及术后继发感染、胆瘘等，原发肝肿瘤患者术后是否出现胆管转移。
结果：胆总管扩张18例；所有病例均同时伴有肝内胆管扩张，左侧肝内胆管较右侧肝内胆管扩张明显，其中单纯性胆管扩张5例，13例由于胆泥致胆总管及肝内胆管扩张；胆管感染合并肝内胆管扩张积气2例，胆漏4例；肝外胆管转移性肿瘤2例。
结论：双螺旋CT和MR均能显示肝移植术后胆系并发症影像，MRI及磁共振胰胆管造影、内镜逆行胰胆管造影、引流管造影均能清楚显示胆管形态及胆管胆泥，MRI较CT更能清楚显示胆泥形成。
关键词：肝移植；胆道疾病；手术后并发症；诊断显像；器官移植

董其龙，陈代文，史震山，钟群，陈自谦.肝移植术后胆系并发症影像学特点及对防治的提示[J].中国组织工程研究与临床康复，2008，12(18):3410-3414 [www.zglckf.com/zglckf/ejournal/upfiles/08-18/18k-3410(ps).pdf]

Imaging characters and prevention implies of biliary complications after liver transplantation

Abstract

BACKGROUND: As common complications after liver transplantation, biliary complications can be directly shown by imaging.
OBJECTIVE: To systematically analyze the imaging characters of biliary complications after liver transplantation, to evaluate postoperative outcome and provide reference for the prevention and treatment of postoperative complications.
DESIGN, TIME AND SETTING: Retrospective analysis was performed at Department of Radiology, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from January 2002 to December 2006.
PARTICIPANTS: Thirty-four cases with biliary complications after orthotopic liver transplantation in Department of Hepatobiliary Surgery, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA were selected, including 27 males and 7 females. All patients were bile commen duct end-to-end anastomosis.
METHODS: The CT, MRI and endoscopic retrograde cholangiopancreatography (ERCP) imaging characters of 34 cases after orthotopic liver transplantation were studied retrospectively. Twenty-four cases were detected by multislice CT, of which 5 cases also checked with ERCP (2 cases undergone drainage tube opacification); 8 cases were detected by MR and magnetic resonance cholangiopancreatography (MRCP).
MAIN OUTCOME MEASURES: Dilatation, stenosis, bilestone, intrahepatic pneumatosis, secondary infection, and biliary fistula in bile commen duct and intrahepatic bile duct; bile duct metabasis in patients.
RESULTS: Eighteen cases showed choledochus dilatation complicated by intrahepatic bile duct dilatation. The left intrahepatic bile duct dilatation was greater than the right side. Of 18 cases, 5 only showed bile duct dilation, 13 had choledochus and intrahepatic dilatation caused by bilestone, and 2 had biliary tract infection complicated by intrahepatic bile duct dilatation and pneumatosis. In addition, 4 cases had biliary fistula, and 2 cases had metastatic tumor of extrahepatic bile duct.
CONCLUSION: Double spiral CT and MR can show the imaging of biliary complications after liver transplantation. MRI, MRCP, ERCP and the opacification of drainage tube can show the shape of bile duct and bilestone in the biliary tract. And MRI can display the bilestone more clearly than CT.

Dong QL, Chen DW, Shi ZS, Zhong Q, Chen ZQ.Imaging characters and prevention implies of biliary complications after liver transplantation.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(18):3410-3414
[www.zglckf.com/zglckf/ejournal/upfiles/08-18/18k-3410(ps).pdf]