Miller W J, Campbell W L, Zajko A B, Pinna A, Zetti G, Stieber A C, Foster R G, Lecky J W, Lee K Y
Department of Radiology, University of Pittsburgh School of Medicine, Presbyterian University Hospital, PA 15213.
AJR Am J Roentgenol. 1991 Jul;157(1):29-32. doi: 10.2214/ajr.157.1.2048532.
Biliary obstruction in liver transplants is most commonly due to stricture at the biliary anastomosis. The native common bile duct typically is normal. We retrospectively studied 28 patients with choledochocholedochostomy anastomoses who had marked native and donor extrahepatic bile duct dilatation associated with clinical evidence of biliary obstruction. Operative cholangiograms were compared with postoperative cholangiograms obtained a mean of 50 weeks (range, 2-246 weeks) later. Mean caliber of the native common bile duct increased from 7.5 +/- 2.0 mm on operative cholangiograms to 14.8 +/- 3.9 mm on postoperative cholangiograms (p less than .001). Mean caliber of the donor common hepatic duct increased from 5.9 +/- 1.3 mm on operative cholangiograms to 12.8 +/- 3.8 mm on postoperative cholangiograms (p less than .001). Dilatation of the cystic duct remnant was seen in 15 patients. All patients had surgical revision to choledochojejunostomy with improved results of liver function studies in most cases. Diffuse dilatation of native and donor extrahepatic bile ducts may develop in liver transplant recipients. Typical features include native and donor extrahepatic ducts greater than 12 mm in diameter and a dilated cystic duct remnant on postoperative cholangiography in a patient with otherwise unexplained hepatic dysfunction.
肝移植中的胆管梗阻最常见的原因是胆管吻合口狭窄。天然胆总管通常是正常的。我们回顾性研究了28例行胆总管-胆总管吻合术的患者，这些患者存在明显的天然和供体肝外胆管扩张，并伴有胆管梗阻的临床证据。将术中胆管造影与平均50周（范围2 - 246周）后获得的术后胆管造影进行比较。术中胆管造影显示天然胆总管平均管径为7.5±2.0毫米，术后胆管造影显示为14.8±3.9毫米（p<0.001）。术中胆管造影显示供体肝总管平均管径为5.9±1.3毫米，术后胆管造影显示为12.8±3.8毫米（p<0.001）。15例患者可见胆囊管残端扩张。所有患者均接受了胆总管-空肠吻合术的手术修正，大多数病例肝功能检查结果有所改善。肝移植受者可能会出现天然和供体肝外胆管的弥漫性扩张。典型特征包括直径大于12毫米的天然和供体肝外胆管，以及在术后胆管造影中出现胆囊管残端扩张，且患者存在无法解释的肝功能障碍。
