中文摘要：

目的探讨肝移植后不同类型胆道狭窄的造影特点，并探讨其与病因的联系。方法46例肝移植受者，术后发生黄疸，行经皮经肝胆道造影（PTC）及经皮肝穿刺组织病理学检查证实诊断；1例行肝动脉造影检查，45例行多层CT检查及肝动脉重建。回顾性分析其胆道造影表现，对胆道狭窄类型进行分类，利用Fisher确切概率法分析不同类型胆道狭窄患者的肝内、外胆道形态学改变的异同点，并结合发病机制加以阐述。结果PTC证实吻合口狭窄（ABS）为21例，非吻合口狭窄（NBS）为25例，其中NBS伴肝动脉栓塞（HAT）13例，不伴HAT12例。PTC示肝门区胆管狭窄患者共26例，NBS患者（发生率92．0％）发生肝门区胆管狭窄明显多于ABS患者（发生率14．3％，P〈0．05）。肝内胆管狭窄患者共31例，NBS患者（发生率100．0％）发生肝内胆管狭窄明显多于ABS患者（发生率28．6％0，P〈0．05）。肝内胆管扩张患者共33例，不合并HAT的NBS患者（发生率16．7％）发生肝内胆管扩张明显少于ABS患者（发生率100．0％）及合并HAT的NBS患者（发生率76．9％，P〈0．05）。肝外胆管扩张患者共21例，ABS患者（发生率85．7％）发生肝外胆管扩张明显多于NBS患者（发生率12．0％，P〈0．05）。肝内胆管狭窄、扩张同时出现的患者共18例，AKS患者肝内胆管扩张较多见（发生率100．0％），不合并HAT的NBS患者以肝内胆管狭窄多见（发生率100．0%），但合并HAT的NBS患者（发生率76．9％）出现肝内胆管狭窄并扩张明显多于ABS患者（28．6％）及不合并HAT的NBS患者（发生率16．7％，P〈0．05）。46例经皮肝穿刺组织病理学检查表现符合胆管狭窄的诊断。结论肝移植后ABS患者、合并及不合并HAT的NBS患者的造影表现有不同的特点，其胆管狭窄及扩张部位不同。

英文摘要：

Objective To investigate the imaging characteristics of different biliary strictures after liver transplantation and their relationship with causes. Methods Forty-six patients with jaundice and biliary stricture were enrolled in this study. The diagnosis was confirmed by percutaneous transhepatic cholangiography （PTC）. All the patients had hepatic arteriography with DSA or CTA and underwent liver biopsy. Their imaging characteristics were analyzed and the related statistic analysis was conducted. Results Anastomosis biliary stricture （ABS） was demonstrated in 21 cases, and non-anastomosis biliary stricture （NBS） with hepatic artery thrombosis （HAT） occurred in 13 cases, and there were 12 cases of NBS without HAT. PTC examination confirmed there were 26 cases of biliary stricture at hepatic hilum, and the incidence of biliary stricture in NBS group was significantly higher than that in ABS group （92% vs. 14. 35%, P〈0. 05）. There were 31 cases of intrahepatic bile duct stricture, and the incidence in NBS group was significantly higher than that in ABS group （100% vs. 28. 6%, P〈0. 05）. There were 33 cases of dilatation of intrahepatic bile duct, and the incidence in NBS without HAT group was significantly lower than that in ABS group and NBS with HAT group （16. 7%, 100% and 76. 9% respectively） （P〈0. 05）. There were 21 cases of extrahepatic biliary dilatation, and the incidence in ABS group was significantly higher than that in ABS group and NBS without HAT group （76. 9%, 28. 6% and 16. 7% respectively, P〈0. 05）. The results of the liver biopsy were accorded with the diagnosis of biliary stricture. Conclusion The different biliary strictures carry different imaging characteristics, including location of biliary stricture, and location and type of secondary biliary dilatation.