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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2019, Vol. 08 ›› Issue (03) : 247 -251. doi: 10.3877/cma.j.issn.2095-3232.2019.03.016

所属专题： 文献；

临床研究

肝癌肝移植术后腹部肝外转移的常规超声及超声造影表现
张红君1, 毛永江1, 郑博文1, 廖梅1, 任杰1,†()   
  1. 1. 510630　广州，中山大学附属第三医院超声科
  • 收稿日期:2019-02-14 出版日期:2019-06-10
  • 通信作者: 任杰
  • 基金资助:
    广东省自然科学基金团队项目(2015A030312013)

Conventional and contrast-enhanced ultrasonography findings of extrahepatic abdominal metastasis after liver transplantation for primary liver cancer

Hongjun Zhang1, Yongjiang Mao1, Bowen Zheng1, Mei Liao1, Jie Ren1,†()   

  1. 1. Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2019-02-14 Published:2019-06-10
  • Corresponding author: Jie Ren
  • About author:
    Corresponding author: Ren Jie, Email:
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引用本文：

张红君, 毛永江, 郑博文, 廖梅, 任杰. 肝癌肝移植术后腹部肝外转移的常规超声及超声造影表现[J]. 中华肝脏外科手术学电子杂志, 2019, 08(03): 247-251.

Hongjun Zhang, Yongjiang Mao, Bowen Zheng, Mei Liao, Jie Ren. Conventional and contrast-enhanced ultrasonography findings of extrahepatic abdominal metastasis after liver transplantation for primary liver cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(03): 247-251.

目的

探讨原发性肝癌（肝癌）患者肝移植术后腹部肝外转移的常规超声及超声造影表现。

方法

回顾性分析2008年12月至2018年12月中山大学附属第三医院收治的50例肝癌肝移植术后腹部肝外转移患者临床资料。其中男49例，女1例；平均年龄（51±9）岁。原发病：肝细胞癌49例，胆管细胞癌1例。患者均签署知情同意书，符合医学伦理学规定。采用常规超声和（或）超声造影进行肝移植术后复查，总结肝癌肝移植术后腹部肝外转移灶的常规超声和超声造影声像学特点。

结果

超声首次检出时间为17 d～50个月，中位时间7个月。超声首次检出时转移灶直径为0.7～11.1 cm，中位直径2.6 cm。多发性转移灶45例，伴肝内转移35例。转移部位：第一肝门区淋巴结30例，肠系膜淋巴结20例。转移灶形态规则，与周边组织分界清晰36例；病灶之间有融合12例。病灶内部表现为均匀低回声47例，不规则液化坏死区域3例，均无明显钙化。彩色多普勒超声检查病灶内部有彩色血流信号15例。16例同时进行了超声造影检查，病灶不均匀增强13例，其中周边厚环状增强7例，不规则增强5例，不规则带状增强1例。

结论

超声检查对肝癌肝移植术后腹部肝外转移可以有效检出，转移灶大部分表现为多发、边界清晰、均匀的低回声团，仅有小部分病灶内可探及彩色血流信号。

关键词: 肝肿瘤, 肝移植, 肿瘤转移, 超声检查
Objective

To investigate the findings of conventional and contrast-enhanced ultrasound of extrahepatic abdominal metastasis in patients with primary liver cancer (PLC) after liver transplantation (LT).

Methods

Clinical data of 50 PLC patients with extrahepatic abdominal metastases after LT admitted to the Third Affiliated Hospital of Sun Yat-sen University from December 2008 to December 2018 were retrospectively analyzed. Among them, 49 patients were male and 1 female, aged (51±9) years on average. Primary diseases: 49 cases were diagnosed with hepatocellular carcinoma and 1 case of cholangiocarcinoma. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were followed up after LT by receiving conventional and/or contrast-enhanced ultrasonography. The ultrasonographic manifestations of extrahepatic abdominal metastases were summarized.

Results

The time of initial detection of metastatic lesions by ultrasound was 17 d-50 months with a median time of 7 months. The diameter of metastatic lesions was ranged from 0.7 to 11.1 cm with a median diameter of 2.6 cm when first detected by ultrasound. Multiple metastases were found in 45 cases, of whom 35 cases were complicated with intrahepatic metastases. Metastatic sites: 30 cases of lymph nodes in the porta hepatis, 20 cases of lymph nodes in the mesentery. The metastatic lesions in 36 cases were in regular shape and had clear boundary with surrounding tissues. And the metastatic lesions in 12 cases had no clear boundary. Homogeneous hypoecho was detected within the lesions in 47 cases and irregular liquefaction necrosis in 3 cases without evident signs of calcification. Color doppler flow signals were found inside the lesions in 15 cases by color Doppler ultrasound. 16 cases also received contrast-enhanced ultrasonography. Lesions with uneven enhancement were found in 13 cases, including 7 cases of peripheral thick annular enhancement, 5 cases of irregular enhancement and 1 case of irregular band enhancement.

Conclusions

Ultrasonography can effectively detect the extrahepatic abdominal metastases of PLC after LT. Most of the metastatic lesions are multiple, with well-defined boundary and homogeneous hypoechoic masses, whereas color blood flow signals can be detected in small portion of lesions.

Key words: Liver neoplasms, Liver transplantation, Neoplasm metastasis, Ultrasonography
图1 一例肝癌肝移植术后患者肝外腹部转移瘤超声检查图
[1]
Kim YK,Lee KW,Cho SY, et al. Usefulness 18F-FDG positron emission tomography/computed tomography for detecting recurrence of hepatocellular carcinoma in posttransplant patients[J]. Liver Transpl, 2010, 16(6):767-772.
[2]
Jun L,Zhenlin Y,Renyan G, et al. Independent factors and predictive score for extrahepatic metastasis of hepatocellular carcinoma following curative hepatectomy[J]. Oncologist, 2012, 17(7):963-969.
[3]
Teegen EM,Mogl MT,Pratschke J, et al. Adrenal metastasis of hepatocellular carcinoma in patients following liver resection or liver transplantation: experience from a tertiary referral center[J]. Int J Surg Oncol, 2018:4195076.
[4]
Chok KSh. Management of recurrent hepatocellular carcinoma after liver transplant[J]. World J Hepatol, 2015, 7(8): 1142-1148.
[5]
Wu L,Swan P,McCall J, et al. Intention-to-treat analysis of liver transplantation, resection and thermal ablation for hepatocellular carcinoma in a single centre[J]. HPB, 2018, 20(10):966-976.
[6]
Patkowski W,Stankiewicz R,Grąt M, et al. Poor outcomes after liver transplantation in patients with incidental cholangiocarcinoma irrespective of tumor localization[J]. Transplant Proc, 2014, 46(8): 2774-2776.
[7]
Fernandez-Sevilla E,Allard MA,Selten J, et al. Recurrence of hepatocellular carcinoma after liver transplantation: is there a place for resection?[J]. Liver Transpl, 2017, 23(4):440-447.
[8]
Sneag DB,Krajewski K,Giardino A, et al. Extrahepatic spread of hepatocellular carcinoma: spectrum of imaging findings[J]. AJR Am J Roentgenol, 2011, 197(4):W658-664.
[9]
Liu D,Chan AC,Fong DY, et al. Evidence-based surveillance imaging schedule after liver transplantation for hepatocellular carcinoma recurrence[J]. Transplantation, 2017, 101(1):107-111.
[10]
曾婕，郑荣琴，任杰，等．肝移植术后肝癌复发的二维超声及超声造影表现[J/CD]．中华医学超声杂志（电子版），2010, 7(4): 666-670.
[11]
Girometti R,Como G,Bazzocchi M, et al. Post-operative imaging in liver transplantation: state-of-the-art and future perspectives[J]. World J Gastroenterol, 2014, 20(20):6180-6200.
[12]
Shi G,Wang C,Zhang P, et al. Donor polymorphisms of toll-like receptor 4 rs1927914 associated with the risk of hepatocellular carcinoma recurrence following liver transplantation[J]. Arch Med Res, 2017, 48(6):553-560.
[13]
Chiorean L,Tana C,Braden B, et al. Advantages and limitations of focal liver lesion assessment with ultrasound contrast agents: comments on the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines[J]. Med Princ Pract, 2016, 25(5):399-407.
[14]
Wan P,Xia Q,Zhang JJ, et al. Liver transplantation for hepatocellular carcinoma exceeding the Milan criteria: a single-center experience[J]. J Cancer Res Clin Oncol, 2014, 140(2):341-348.
[15]
Sharma P,Welch K,Hussain H, et al. Incidence and risk factors of hepatocellular carcinoma recurrence after liver transplantation in the MELD era[J]. Dig Dis Sci, 2012, 57(3):806-812.
[16]
刘子荣，张雅敏．肝癌肝移植术后复发转移的防治与评估[J]．中华肝胆外科杂志，2018, 24(6):424-426.
[17]
Lu D,Zhuo J,Yang M, et al. The association between donor genetic variations in one-carbon metabolism pathway genes and hepatitis B recurrence after liver transplantation[J]. Gene, 2018(663): 121-125.
[18]
任秀昀，李春伶，徐惠，等．肝细胞癌肝移植术后肝内复发灶的超声造影参数成像分析[J]．中华超声影像学杂志，2012, 21(10): 864-867.
[19]
Sidhu PS,Cantisani V,Dietrich CF, et al. The EFSUMB Guidelines and Recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (long version)[J]. Ultraschall Med, 2018, 39(2):e2-44.
[20]
Jin Y,He YS,Zhang MM, et al. Value of contrast-enhanced ultrasonography in the differential diagnosis of enlarged lymph nodes: a meta-analysis of diagnostic accuracy studies[J]. Asian Pac J Cancer Prev, 2015, 16(6):2361-2368.
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