胆道闭锁疑似病例的临床特征和诊断依据分析  

Analysis of the clinical features and diagnostic criteria for suspected cases of biliary atresia

作　　者：孙松[1] 陈功[1] 郑珊[1] 俞蕙[2] 徐梦华[3] 

机构地区：[1]复旦大学附属儿科医院外科,上海201102 [2]复旦大学附属儿科医院儿童肝病中心,上海201102 [3]复旦大学附属儿科医院儿科研究所,上海201102

出　　处：《中华小儿外科杂志》2012年第11期801-804,共4页Chinese Journal of Pediatric Surgery

基　　金：卫生部新生儿重点实验室基金

摘　　要：目的回顾手术确诊非胆道闭锁和胆道闭锁两组病例的临床资料，分析胆道闭锁疑似病例的临床特征和术前疑诊为胆道闭锁的原因。方法收集2004年至2010年本院术前拟诊为胆道闭锁而行腹腔镜或开腹胆道造影的602例患儿的临床资料，依据术中胆道造影的诊断结果分为非胆道闭锁组和胆道闭锁组。分析近年非胆道闭锁病例所占比例，对照两组患儿黄疸发生日龄、肝功能及B型超声结果。计算同位素肝胆排泄性造影诊断胆道闭锁的阳性预测值及假阳性率，以及非胆道闭锁病例的疾病构成。结果非胆道闭锁组83例，胆道闭锁组519例。近年行手术探查的所有患儿中非胆道闭锁比例无明显下降。两组出现黄疸的日龄、入院TBIL（169．9mmol／L比172．3mmol／L，P〉0．05）、DBIL（128．7mmol／L比132．5mmol／L，P〉0．05）、DBIL／TBIL（0．76比0．77，P〉0．05）、ALT（141．3mmol／L比114．9mmol／L，P〉0．05）比较均无统计学差异。γ-GT非胆道闭锁组显著低于胆道闭锁组（263．2mmol／L比902．7mmol／L，P〈0．01），B型超声检查肝脏肋下大小，非胆道闭锁组小于胆道闭锁组（2．99比3．61，P％0．01）。同位素肝胆排泄性造影阳性患儿共498例，其中术后诊断为非胆道闭锁患儿66例，假阳性率为13．3％。83例非胆道闭锁组包括：婴儿肝炎综合征58例，胆道发育不良16例，TPN相关性胆汁淤积症5例，胆道穿孔和浓缩胆栓综合征各2例。结论肝功能检查的相似性及过度依赖同位素肝胆排泄性造影可能是非胆道闭锁患儿疑诊为胆道闭锁的主要原因，术前仔细分析黄疸出现的日龄、γ-GT、B型超声检查肝脏大小有利于非胆道闭锁病例术前的鉴别诊断。Objective To analyse the clinical teatures and causes ot misdlagnosis of biliary atre-sia in a retrospective study. Methods Six hundred and two infants who were suspected to have biliary atresia were recruited into our study from 2004 to 2010. All cases were divided into non-biliary atresia group and biliary atresia group according to intraoperative cholangiography findings. The annual pro portion of patients was calculated, while the time of the occurrence of juandice, liver function and ul trasound results in two groups were compared. Moreover, the positive predictive value and false posi-tive rate of hepatobiliary scintigraphy in biliary atresia were calculated. In addition, the disease spec-trum of non biliary atresia group patients was analysed. Results In the 602 cases, 83 patients were diagnosed to be in non-biliary atresia group. The remaining 519 cases were comfirmed to have biliary atresia. There was no significant decline in the proportion of non biliary atresia in all cases by years. Time of the occurrence of jaundice, TBIL（ 169. 9 mmol/L vs 172.3 mmol/L, P〉0. （15）, DBIL（128.7 mmol/L vs 132. 5 mmol/L,P〉0. 05）, DBII./TBIL（0. 76 vs 0. 77, P〉0. 05） and ALT（141.3 mmol/ L vs 114. 9 mrnol/L,P〉0.1）5） values before cholangiography showed no statistically significant differ-ence between these two groups. However, the mean level of γ-GT was 263.2 mmol/1 in non-biliary atresia group while 902. γ mmol/1 in biliary atresia group（P〈0. 001 ）. The liver size below the costal margin detected with ultrasound was smaller in non-biliary atresia group than that in biliary atresia group （2.99 cm and 3.61 cm respectively,P〈0.05）. Among the 498 infants who received hepatohili-ary scintigraphy examination, the false positive rate was 13.3% （66/498） and the positive predictive value was 86. 7% （432/498）. In the non-biliary atresia group, 58 infants suffered from hepatitis syn- drome, 16 cases were biliary dysplasia, 5 cases were TPN related eholestasis, two cases were bile duct

关 键 词：胆道闭锁 鉴别诊断 疑似病例 

分 类 号：R726.5[医药卫生—儿科]