探讨超声检查在肝移植术后胆道并发症中的应用价值。

回顾性分析2003年10月至2010年1月在中山大学附属第三医院接受诊治的52例肝移植术后胆道并发症患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男49例，女3例；平均年龄（48±18）岁。采用彩色多普勒超声（彩超）对移植肝行全面检查，观察指标包括胆管扩张，胆管壁增厚，胆管壁回声增强，肝门部胆管腔变细，胆管腔内回声、声影，肝内外局限性暗区等征象。

肝移植术后胆道并发症的主要超声检查表现：96%（50/52）胆管扩张，75%（39/52）胆管壁回声增强，62%（32/52）胆管壁增厚，54%（28/52）胆管腔变细，37%（19/52）胆管内胆泥、胆石形成。胆管狭窄的直接征象为胆管腔变细，间接征象包括胆管扩张、胆管壁增厚、胆管壁回声增强等。胆管内胆泥、胆石形成表现为胆管腔内中等回声或高回声团后伴有声影，呈局限性或弥漫性分布。胆漏表现为肝门部或肝下间隙局限性暗区。胆汁瘤表现为肝内散在分布片状高回声区或低回声暗区。

肝移植术后胆道并发症具有较为典型的超声检查征象，超声检查可为肝移植术后胆道并发症提供诊断依据。

To investigate the application value of ultrasonography in biliary complications after liver transplantation.

Clinical data of 52 patients who developed biliary complications after liver transplantation and treated in the Third Affiliated Hospital of Sun Yat-sen University between October 2003 and January 2010 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 52 patients, 49 were males and 3 were females with the average age of (48±18) years old. Liver grafts were thoroughly examined with color Doppler ultrasound (CDUS). The observation indexes included dilation of bile duct, thickening of bile duct wall, echo enhancement of bile duct wall, narrowing of hilar biliary duct lumen, intraductal echo and acoustic shadow as well as intrahepatic and extrahepatic local dark areas.

The major ultrasonographic manifestations of biliary complications after liver transplantation were 96% (50/52) dilation of bile duct, 75% (39/52) echo enhancement of bile duct wall, 62% (32/52) thickening of bile duct wall, 54% (28/52) narrowing of biliary duct lumen and 37% (19/52) formation of intrahepatic biliary sludge and biliary calculus. The direct ultrasonographic sign of biliary stricture was the narrowing of biliary duct lumen and the indirect signs included dilation of bile duct, thickening of bile duct wall and echo enhancement of bile duct wall. Formation of intrahepatic biliary sludge and biliary calculus manifested a local or diffuse acoustic shadow behind the medium or high echo mass. Bile leakage manifested a local dark space in portal hepatis or subhepatic space. Biloma manifested a dispersed intrahepatic patchy high-echo area or low-echo dark area.

Biliary complications after liver transplantation have typical ultrasonographic signs. Ultrasonography may provide diagnostic evidence for biliary complications after liver transplantation.