高频超声对婴儿胆汁淤积性肝病的鉴别诊断  

The differential diagnostic value of high-frequency ultrasonography in infantile cholestatic hepatopathy

作　　者：肖婷[1] 陈云超[1] 刘娜[1] 黄志华[2] 刘艳[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院超声影像科,武汉430030 [2]华中科技大学同济医学院附属同济医院儿科,武汉430030

出　　处：《中华超声影像学杂志》2017年第3期249-253,共5页Chinese Journal of Ultrasonography

摘　　要：目的应用高频超声对胆汁淤积性肝病婴儿进行检查，并与其他诊断方法对比，探讨其对胆道闭锁（biliaryatresia，BA）的鉴别诊断价值及优越性。方法124例胆汁淤积性肝病婴儿空腹4h后行高频超声检查，观察患儿肝脏大小、回声、肝门部结构、胆管、胆囊、肝右动脉等，同时收集其临床表现及血生化、磁共振胰胆管造影（MRcholangiopancreatography，MRCP）、十二指肠胆汁引流、肝穿病理学等资料。结果124例患儿中，BA61例，非BA63例，超声显示两组患儿纤维斑块（TC征）、胆囊长宽径、肝右动脉差异均有统计学意义（均P〈0．001），其中结合TC征及胆囊壁或形态异常诊断BA准确性最高，可达90．3％。其他方法准确率分别为：大便颜色83．1％，γ-GT81．5％，MRCP47．5％，十二指肠胆汁引流83．3％，肝穿病理95．2％。结论高频超声具有诊断率高、简便、无创、经济等优点，是诊断BA的首选方法。Objective To evaluate the differential diagnostic value and superior of biliary atresia（BA） in the infants with cholestatic hepatopathy by high frequency ultrasonography （HUS）. Methods After 4 hours fasting, 124 infants with cholestatic hepatopathy were scanned with high frequency US. The data of hepatic size and parenchyma, gallbladder, triangular cord （TC） sign, bile duct, right hepatic artery （RHA） and portal vein （PV） were observed and measured. Meanwhile, the other data were collected, which included the clinical diagnosis, blood biochemical tests, the MRCP and dynamic duodenal liquid color check finding, the pathological results after liver puncture biopsy and so on. Results In 124 infants with cholestatic hepatopathy, BA was found in 61 infants and ruled out in 63. TC thickness, RHA diameter, and gallbladder length and width exhibited significant differences between the group with BA and the group non BA（all P 0. 001 ）. The correctness for the diagnosis of BA was 90.3 % by the combination of TC sign and abnormal gallbladder morphology, and 83.1% by stool color, 81.5 % by γ-GT, 47.5 % by MRCP, 83.3 % by dynamic duodenal liquid color check, 95.2 % by the pathology after liver puncture biopsy, respectively. Conclusions HUS is superior to other diagnostic methods in BA with higher accuracy rate, noninvasion, simplicity and economy.

关 键 词：超声检查 胆汁淤积 婴儿 

分 类 号：R445.1[医药卫生—影像医学与核医学] R725.7[医药卫生—诊断学]