Sheng R, Ramirez C B, Zajko A B, Campbell W L
Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA.
Radiology. 1996 Jan;198(1):243-7. doi: 10.1148/radiology.198.1.8539387.
To determine the prevalence, radiologic features, and clinical significance of bile duct filling defects (BDFDs) in liver transplant recipients studied with cholangiography.
During 13 years, 4,100 cholangiograms were obtained in 1,650 patients. All studies showing BDFD suggestive of stones, sludge, cast, or necrotic debris were retrospectively evaluated.
The prevalence of BDFD was 5.7% (n = 94). On the basis of cholangiographic appearance, BDFDs were categorized as sludge or cast in 53 grafts (56%), stones in 32 (34%), and necrotic debris in nine (10%). Forty-three patients (46%) underwent surgical biliary reconstruction, while 14 (15%) underwent interventional radiologic treatments. Twenty-four of 32 stones (75%) were treated with surgical reconstruction, compared with 31% (19 of 62 grafts) of other BDFDs (P < .0001). Necrotic debris and sludge were associated with hepatic artery occlusion in seven of nine (78%) and 16 of 53 (30%) grafts, respectively.
Stones and sludge are relatively infrequent after liver transplantation but are associated with high morbidity. Surgical or interventional radiologic treatments are usually performed. Bile duct stones are usually treated with surgical biliary reconstruction. While debris and bile duct necrosis are due to ischemia from hepatic artery occlusion, sludge may also have an ischemic pathogenesis in some cases.
确定在接受胆管造影检查的肝移植受者中胆管充盈缺损（BDFDs）的患病率、放射学特征及临床意义。
在13年期间，对1650例患者进行了4100次胆管造影检查。所有显示提示结石、胆泥、铸型或坏死碎片的BDFDs的研究均进行回顾性评估。
BDFDs的患病率为5.7%（n = 94）。根据胆管造影表现，BDFDs在53例移植物（56%）中被分类为胆泥或铸型，32例（34%）为结石，9例（10%）为坏死碎片。43例患者（46%）接受了外科胆管重建，而14例（15%）接受了介入放射治疗。32例结石中有24例（75%）接受了外科重建治疗，相比之下，其他BDFDs中有31%（62例移植物中的19例）接受了该治疗（P < .0001）。坏死碎片和胆泥分别与9例中的7例（78%）和53例中的16例（30%）移植物的肝动脉闭塞相关。
肝移植后结石和胆泥相对少见，但与高发病率相关。通常进行外科或介入放射治疗。胆管结石通常采用外科胆管重建治疗。虽然碎片和胆管坏死是由于肝动脉闭塞导致的缺血，但在某些情况下胆泥也可能有缺血性发病机制。
