【摘要】 目的 探讨肝移植术后胆道狭窄的早期多模态超声改变。方法 2018年9月至2020年8月共159例患者在深圳市第三人民医院行肝脏移植手术。其中28例术后诊断为胆道狭窄，采用随机数字表法在剩余患者中选取37例无任何并发症的患者作为对照组。比较两组患者肝动脉阻力指数（resistance index,RI）、峰值流速（peak systolic velocity,PSV）、胆道扩张发生率及胆道缺血发生率的差异。结果 胆道狭窄组患者术后第1 d左肝动脉PSV显著低于对照组（中位数：38.5 cm/s vs 53.0 cm/s;z=-2.837,P=0.005），两组患者右肝动脉PSV差异无统计学意义（中位数：46.5 cm/s vs 51.0 cm/s;z=-1.279,P=0.201）。胆道狭窄组患者左肝动脉和右肝动脉RI减低发生率均显著高于对照组[39.3%(11/28)vs 10.8%(4/37)，χ2=7.280,P=0.007;32.1%(9/28)vs 10.8%(4/37)，χ~2=4.533,P=0.033]，胆道狭窄组患者左肝动脉RI正常的发生率显著低于对照组[50.0%(14/28)vs83.8%(31/37)，χ~2=8.540,P=0.003]，两组患者间右肝动脉RI正常和左右侧肝动脉RI升高发生率差异均无统计学意义[60.7%(17/28)vs 78.4%(29/37)，χ~2=2.404,P=0.121;10.7%(3/28)vs 5.4%(2/37)，χ~2=0.106,P=0.745;7.1%(2/28)vs 10.8%(4/37)，χ~2=0.005,P=0.942]。胆道狭窄组患者术后三级胆道扩张发生率显著高于对照组[57.1%(16/28)vs 10.8%(4/37)]，差异有统计学意义（χ~2=16.062,P <0.001）。超声造影示胆道狭窄组患者胆道缺血发生率显著高于对照组[57.1%(16/28)vs 10.8%(4/37)]，差异有统计学意义（χ~2=16.062,P <0.001）。结论 肝移植术后胆道狭窄与肝动脉血流及胆道壁灌注有关，多模态超声监测肝动脉及胆道壁有助于早期发现胆道狭窄。更多还原

【Abstract】 Objective To investigate the early multimodal ultrasound changes in biliary strictures after liver transplantation. Methods Total of 159 patients who underwent liver transplantation in Shenzhen Third People’s Hospital from September 2018 to August 2020,among which 28 patients were diagnosed as biliary stenosis, another 37 patients without any complications were selected as the control group by random digital table method. Resistance index(RI), peak systolic velocity(PSV), incidence of biliary dilatation and incidence of biliary ischemia of patients between the two groups were compared. Results PSV of the left hepatic artery on the first postoperative day of patients in biliary stricture group was significantly lower than that of control group(median: 38.5 cm/s vs 53.0 cm/s; z =-2.837, P =0.005). There were no statistically significant difference of PSV of the right hepatic artery of patients between the two groups(median: 46.5 cm/s vs 51.0 cm/s; z =-1.279, P = 0.201). The incidence of RI reduction in left hepatic artery and right hepatic artery of patients in biliary stricture group were significantly higher than those of the control group [39.3%(11/28) vs 10.8%(4/37), χ2 = 7.280, P = 0.007; 32.1%(9/28) vs 10.8%(4/37), χ2 = 4.533, P = 0.033],the incidence of normal RI of left hepatic artery of patients in biliary stricture group was significantly lower than that of control group [50.0%(14/28) vs 83.8%(31/37), χ2 = 8.540,P = 0.003], there were no significant difference in the incidence of normal RI in the right hepatic artery and RI elevation in the left and right hepatic arteries of patients between the two groups [60.7%(17/28) vs 78.4%(29/37), χ2 = 2.404, P = 0.121; 10.7%(3/28) vs 5.4%(2/37),χ2 = 0.106, P = 0.745; 7.1%(2/28) vs 10.8%(4/37), χ2 = 0.005, P = 0.942]. The incidence of postoperative tertiary biliary dilatation of patients in biliary stricture group was significantly higher than that of control group [57.1%(16/28) vs 10.8%(4/37); χ2 = 16.062, P < 0.001].Ultrasonography showed that the incidence of biliary ischemia of patients in biliary stricture group was significantly higher than that in control group [57.1%(16/28) vs 10.8%(4/37); χ2 =16.062, P < 0.001]. Conclusions Biliary stenosis after liver transplantation was associated with hepatic artery blood flow and biliary wall perfusion. Multimodal ultrasound monitoring of the hepatic artery and biliary wall could help detecting biliary stenosis early.更多还原