超声鉴别囊肿型胆道闭锁与胆总管囊肿的价值  

Value of ultrasonography in differentiating cystic biliary atresia and choledochal cyst

作　　者：于蒲[1,2] 董宁 高擎[1] 李龙 

机构地区：[1]首都儿科研究所附属儿童医院普通(新生儿)外科,北京100020 [2]西安市儿童医院新生儿外科

出　　处：《中华小儿外科杂志》2017年第11期828-831,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的随着超声技术的不断发展，胆道囊性畸形（biliary cystic malformation，BCM）的产前和产后检出率显著增加，该畸形主要包括囊肿型胆道闭锁（cystic biliary atresia，CBA）和胆总管囊肿（choledochal cyst，CC），这两种疾病在超声影像及临床表现方面比较相似，很难区分。本研究目的在于探索CBA与CC在产前及产后阶段是否可以通过超声检查来进行区分，BCM产前B型超声诊断率在两种疾病之间是否存在差异。方法回顾性研究2013年1月至2015年11月年龄小于130d的BCM病例，共98例，经术中胆道造影将其分为CBA组和CC组，其中CBA组31例，CC组67例，并对CBA组和CC组不同时期的囊肿大小、术前超声特征（胆囊形态、大小及肝门处纤维块征象）以及产前B型超声BCM诊断率进行对比分析。结果在产前及生后阶段，CBA组的囊肿体积无明显变化，而CC组的囊肿体积逐渐增大。CBA组与CC组的胆囊大小差异有统计学意义（P＝0.034），31例CBA患儿中23例患儿胆囊萎缩僵硬，但是所有CC组患儿胆囊形态均正常（P〈0.001）。10例CBA患儿探查到肝门处纤维块，CC组患儿均未探查到该征象（P〈0.001）。CBA组的产前超声BCM诊断率显著低于CC组（61.3%比82.1%，P＝0.026）。结论如果B型超声提示囊肿体积在不同时期无明显变化，胆囊萎缩、形态僵硬或肝门处可探查到纤维块，应考虑诊断为胆道闭锁，但并非所有的CBA具有这些典型的超声特征。迄今为止，胆道造影仍是区分CBA和CC的最精确方法。CC组的产前BCM诊断率显著高于CBA组，可能与CC囊肿的不断增大有关。ObjectiveWith the development of ultrasonography, it has boosted prenatal and postnatal diagnoses of biliary cystic malformation （BCM） including cystic biliary atresia （CBA） and choledochal cyst （CC）. Both conditions share similar ultrasonographic patterns and clinical manifestations. This study was intended to explore whether or not CBA could be distinguished by ultrasonography from CC in prenatal and postnatal stage and whether difference in diagnostic ratio of BCM exists between CBA and CC.MethodsRetrospective reviews were conducted for the clinical data of 98 BCM patients aged under 130 days during the period from January 2013 to November 2015. They were divided by intraoperative cholangiography into two groups of CBA （n=31） and CC （n=67）. Chronological changes in cyst volume from prenatal to postnatal period, preoperative ultrasonographic features including gallbladder morphology ＆ size, triangular cord sign and inter-group difference of diagnostic ratio of BCM were analyzed by prenatal ultrasonography.ResultsCyst volume showed no significant change in CBA group but it increased gradually from prenatal to postnatal stage in CC group. Gallbladder size of CBA group was significantly different from that of CC group （P=0.034）. And 23/31 patients had atrophic gallbladder in CBA group, but none in CC group （P〈0.001）. Triangular cord sign was detected in 10 patients in CBA group but none in CC group （P〈0.001）. CBA group had a lower diagnostic ratio of BCM by prenatal ultrasonography than CC group （61.30% vs 82.10%, P=0.026）.ConclusionsCBA should be considered if ultrasonography indicates no significant change in cyst volume in different periods. So far cholangiography has the most effective method of differentiating CBA from CC. The diagnostic ratio of BCM by prenatal ultrasonography in CC group is much higher than that in CBA group. It may be attributed to enlarged cyst size.

关 键 词：胆道闭锁 胆总管囊肿 超声检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R726.5[医药卫生—诊断学]