Sheng R, Campbell W L, Zajko A B, Baron R L
Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA.
AJR Am J Roentgenol. 1996 May;166(5):1109-13. doi: 10.2214/ajr.166.5.8615253.
Biliary strictures occur more frequently after liver transplantation for primary sclerosing cholangitis (PSC) than for other diseases. A hypothesized cause is recurrence of PSC in the liver graft. In our study, we compared cholangiographic features of biliary strictures after transplantation for PSC to those after transplantation for other diseases.
A study group of 32 PSC grafts in adults with biliary strictures was compared with a control group of 32 non-PSC grafts with strictures. Both groups were matched for the type of biliary anastomosis (choledochojejunostomy) and for the time interval between transplantation and stricture diagnosis. We then performed a blind retrospective review of cholangiograms in these 64 cases to evaluate for features of PSC.
Location, number, and length of strictures and ductal dilatation were similar in the PSC and non-PSC groups. Mural irregularities of bile ducts were present in 15 of 32 (47%) PSC grafts compared with four of 32 (13%) in the control group (p=.005). Diverticulum-like outpouchings occurred in six of 32 (19%) PSC graft compared with one of 32 (3%) in the control group. An overall resemblance to PSC was observed in eight of 32 (25%) grafts in the PSC group compared with two of 32 (6%) in the control group.
Mural irregularity and diverticulum-like outpouchings--findings suggestive of PSC--and an overall appearance resembling PSC occur more frequently in PSC transplants than in transplants for other diseases. These findings are consistent with the hypothesis that PSC may recur in liver transplants.
与其他疾病相比，原发性硬化性胆管炎（PSC）患者肝移植后胆道狭窄的发生率更高。一种推测的原因是肝移植中PSC复发。在我们的研究中，我们比较了PSC患者肝移植后胆道狭窄的胆管造影特征与其他疾病患者肝移植后胆道狭窄的胆管造影特征。
将32例患有胆道狭窄的成人PSC移植组与32例患有狭窄的非PSC移植对照组进行比较。两组在胆道吻合类型（胆总管空肠吻合术）以及移植与狭窄诊断之间的时间间隔方面进行了匹配。然后，我们对这64例病例的胆管造影进行了盲法回顾性评估，以评估PSC的特征。
PSC组和非PSC组在狭窄的位置、数量、长度以及胆管扩张方面相似。32例PSC移植中有15例（47%）出现胆管壁不规则，而对照组32例中有4例（13%）出现胆管壁不规则（p = 0.005）。32例PSC移植中有6例（19%）出现憩室样突出，而对照组32例中有1例（3%）出现憩室样突出。PSC组32例移植中有8例（25%）总体表现与PSC相似，而对照组32例中有2例（6%）总体表现与PSC相似。
胆管壁不规则和憩室样突出（提示PSC的表现）以及总体外观与PSC相似在PSC移植中比在其他疾病移植中更常见。这些发现与PSC可能在肝移植中复发的假设一致。
