探讨超声检查在肝移植术后胆管狭窄诊断中的价值。

本前瞻性研究对象为2004年1月至2011年3月在中山大学附属第三医院肝移植中心接受诊治的127例肝移植术后患者。其中男116例，女11例；平均年龄（49±8）岁。所有患者均签署知情同意书，符合医学伦理学规定。首先采用彩色多普勒超声诊断仪检查，超声图像由两名高年资超声科医师进行盲法分析。肝移植术后胆管狭窄的诊断指标为肝门部胆管腔变细、胆管扩张、胆管壁增厚、胆管壁回声增强。以内镜下逆行性胰胆管造影术（ERCP）或经皮经肝胆道造影术（PTC）检查结果作为诊断肝移植术后胆管狭窄的金标准，观察4个单一指标和组合指标的诊断灵敏度和特异度。

肝门部胆管腔变细、胆管扩张、胆管壁增厚、胆管壁回声增强4个单一诊断指标诊断肝移植术后胆管狭窄的灵敏度和特异度分别为0.68和1.00、1.00和0.73、0.71和0.87、0.80和0.70。胆管扩张+胆管壁增厚或胆管壁回声增强的组合诊断指标的灵敏度、特异度均达到0.80。

超声检查有助于肝移植术后胆管狭窄的诊断，肝门部胆管腔变细可作为直接征象诊断肝移植术后胆管狭窄，胆管扩张+胆管壁增厚或胆管壁回声增强的组合诊断指标具有更高的参考价值。

To assess the value of ultrasonography in the diagnosis of biliary stricture after liver transplantation (LT).

A total of 127 patients after LT in Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University from January 2004 to March 2011 were included in this prospective study [116 males, 11 females; average age: (49±8) years old]. The informed consents of all patients were obtained and the ethical committee approval was received. Firstly, color Doppler ultrasound examination was performed in the patients. The ultrasound images were blindedly analyzed by two senior sonographers. The diagnostic indicators of biliary stricture ofter LT were hilar bile duct lumen narrowing, dilatation of bile duct, bile duct wall thickening, echo enhancement of bile duct wall. The endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) results were taken as the gold standard for diagnosing biliary stricture after LT. The diagnostic sensitivity and specificity of the 4 single indicators and combined indicators were observed.

The diagnostic sensitivity and specificity of the 4 single indicators hilar bile duct lumen narrowing, dilatation of bile duct, bile duct wall thickening, echo enhancement of bile duct wall were 0.68 and 1.00, 1.00 and 0.73, 0.71 and 0.87, 0.80 and 0.70. The diagnostic sensitivity and specificity of combined indicators dilatation of bile duct + bile duct wall thickening or echo enhancement of bile duct wall reached 0.80 both.

Ultrasonography is useful in the diagnosis of biliary stricture after LT. Hilar bile duct lumen narrowing can be used as a direct indicator in the diagnosis of biliary stricture after LT. And the combined indicators dilatation of bile duct + bile duct wall thickening or echo enhancement of bile duct wall have higher reference value.