MRI胆管成像诊断婴儿淤胆型黄疸的价值  

MR cholangiography for the diagnosis of cholestasis in infants

作　　者：欧继华 李炳 韩志刚 吴萍 史雪溶 钱晨 OU Jihua;LI Bing;HAN Zhigang;WU Ping;SHI Xuerong;QIAN Chen(Department of Pediatric Surgery,Huai＇an Maternal and Child Health Hospital Affiliated Yangzhou University,Huai＇an,223002,China)

机构地区：[1]扬州大学附属淮安市妇幼保健院放射科,江苏扬州223002 [2]扬州大学附属淮安市妇幼保健院小儿外科,江苏扬州223002 [3]扬州大学附属淮安市妇幼保健院病理科,江苏扬州223002

出　　处：《中国中西医结合影像学杂志》2018年第5期484-486,489,共4页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的:评价单次激发磁共振胆管成像(MRC)在小于3个月婴儿淤胆型黄疸诊断中的应用价值。方法:回顾性分析24例淤胆型黄疸患儿的单次激发MRC资料,年龄5~88 d,平均54 d。胆道闭锁(BA)8例经肛门-肠吻合术(Kasai)术证实;非胆道闭锁(NBA)16例中,4例胆总管囊肿经腹腔镜手术证实,8例胆汁淤积经腹腔镜下胆道造影证实,4例肝炎综合征经临床资料随访黄疸消退证实。观察BA与NBA的MRC表现特点,分析BA的MRC表现与手术病理结果相关性。结果:16例NBA的MRC15例均可见胆囊、左右肝管、肝总管、胆总管,2例肝炎综合征肝门周围部增厚;8例BA的MRC均未见肝外胆管,胆囊未见2例,肝门周围部增厚8例,肝门冠状位MRC呈三角形高信号6例。MRC对BA的诊断准确率为95.8%。8例BA的病理检查示纤维化、胆管增生狭窄、炎症细胞浸润,圆形、裂隙样囊衬以疏松黏液间质和胎儿板状样胆管环绕。结论:单次激发MRC对小于3个月患儿淤胆型黄疸的诊断是一种可靠的非创伤性检查方法,可避免非必要手术。Objective：To retrospectively evaluate the usefulness of single-shot magnetic resonance chonlangiography （MRC） for the diagnosis of cholestasis in neonates and infants younger than 3 months. Methods：Twenty-four consecutive children （age range,5～88 d;mean age,54 d） with cholestatic jaundice underwent single-shot MRC. Diagnosis of BA （BA group,n=8） was confirmed by Kasai operation （portoenterostomy）;Diagnosis of non biliary atresia（NBA group,n=16） was made by operation or clinical follow-up until the jaundice resolved：The four cases of choledochal cyst were confirmed by laparoscopic surgery. The 8 cases cholestasis and 4 hepatitis syndrome were confirmed by laparoscopic-assisted cholangiography and clinical treatment. MRC in the port hepatic were correlated with histopathologic findings of the portal mass. Results：The extrahepatic bile ducts including the gallbladder,the common bile duct,and the left and right hepatic duct were visualized in 15 cases of the NBA group. Periportal thickening was seen in 2 cases with hepatitis syndrome. The extrahepatic bile ducts,except the gallbladder,were not depicted in any cases of the BA group,periportal thickening was seen in all patients. In six of 8 patients high signal intensity was revealed in the triangular area by the coronary position scan. Histopathologic examination of the portal mass revealed features：with bile duct proliferation,bile plugs,periportal fibrosis,inflammatory cell infiltration,and cystic or cleft like lesion surrounded by loose myxoid mesenchyme and plate like fetal bile ducts. Conclusion：single-shot MRC can be a reliable noninvasive imaging tool for the diagnosis of cholestatic jaundice in children younger than 3 months. MRC is recommended to avoid unnecessary surgery.

关 键 词：磁共振胆管成像 胆道闭锁 淤胆型黄疸 婴幼儿 

分 类 号：R725.7[医药卫生—儿科] R445.2[医药卫生—临床医学]