Lim Chang Jin, Hong Kwangpyo, Lee Jeong-Moo, Han Eui Soo, Hong Suk Kyun, Choi YoungRok, Yi Nam-Joon, Lee Kwang-Woong, Suh Kyung-Suk
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Ann Hepatobiliary Pancreat Surg. 2021 Feb 28;25(1):39-45. doi: 10.14701/ahbps.2021.25.1.39.
BACKGROUNDS/AIMS: Biliary complications continue to be the major morbidity and mortality causes following living donor liver transplantation (LT). Endoscopic retrograde cholangiopancreatography (ERCP) has been performed to identify the biliary leakage source. However, this can lead to retrograde cholangitis and pancreatitis, and is not sufficient to diagnose bile leakage from cuts' surface. This study aimed to describe the use of T1-Weighted Magnetic Resonance (MR) Cholangiography with Gd-EOB-DTPA (Primovist) examination for evaluating the bile duct complication following LT.
From March 2012 to December 2018, 869 adult LT were performed at the Seoul National University Hospital. Forty-three recipients had undergone MR Cholangiography with Gd-EOB-DTPA. We reviewed these cases with their clinical outcomes and described the utility of the MR cholangiography with Gd-EOB-DTPA.
In radiologic examinations performed in the patients suspected of bile duct complication, 95% had bile leakage and stricture. Cut surface leakage was diagnosed in two cases, and biliary leakage from the anastomosis site was diagnosed in the others. Most patients with leakage had undergone percutaneous drainage and ERCP, which was performed to evaluate the bile secretion function of the hepatocytes. There was no contrast-enhanced bile duct image in one case with severe rejection, and it might have been related to hepatocyte secretary dysfunction.
T1-Weighted MR Cholangiography with Gd-EOB-DTPA 40-minute delay examination is a feasible and safe non-invasive procedure for identifying biliary leakage sites.
背景/目的：胆道并发症仍然是活体肝移植（LT）术后主要的发病和死亡原因。已采用内镜逆行胰胆管造影（ERCP）来确定胆漏来源。然而，这可能导致逆行性胆管炎和胰腺炎，并且不足以诊断切口表面的胆漏。本研究旨在描述使用钆塞酸二钠（普美显）延迟40分钟的T1加权磁共振（MR）胆管造影检查来评估肝移植术后的胆管并发症。
2012年3月至2018年12月，首尔国立大学医院共进行了869例成人肝移植手术。43例受者接受了钆塞酸二钠增强MR胆管造影检查。我们回顾了这些病例及其临床结果，并描述了钆塞酸二钠增强MR胆管造影的效用。
在疑似胆管并发症患者进行的影像学检查中，95%存在胆漏和狭窄。2例诊断为切口表面漏，其余诊断为吻合口处胆漏。大多数漏诊患者接受了经皮引流和ERCP，后者用于评估肝细胞的胆汁分泌功能。1例严重排斥反应患者未见胆管造影剂增强影像，这可能与肝细胞分泌功能障碍有关。
钆塞酸二钠延迟40分钟的T1加权MR胆管造影检查是一种可行且安全的无创性方法，可用于确定胆漏部位。
