超声在儿童朗格汉斯细胞组织细胞增生症诊治中的价值  

The Value of Ultrasound in the Diagnosis and Treatment of Langerhans′Cell Histiocytosis in Children

作　　者：石静[1] 杜隽[1] 顾凌丰 Shi Jing;Du Jun;Gu Lingfeng(Centre of Imaging Diagnosis,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心影像诊断中心,上海市200127

出　　处：《中国超声医学杂志》2021年第5期546-549,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨超声检查在儿童朗格汉斯细胞组织细胞增生症(LCH)诊治中的价值。方法系统性回顾分析本院确诊为LCH患儿的相关超声影像学资料。结果71例确诊患儿超声检查涉及腹部、甲状腺、骨嗜酸性肉芽肿(EGB)软组织包块三部分。18例高危型多系统LCH患儿的腹部器官存在不同程度的阳性表征,包括肝胆受侵18例、脾脏增大11例、腹部淋巴增大15例、胰腺增大2例、腹腔积液3例。统计分析,碱性磷酸酶(ALKP)指标在胆道累及组与未累及组间存在统计学差异,其升高提示胆道受累。7例多系统LCH患儿存在甲状腺异常,其中4例为迟发型表现,包括结节型5例、条带状1例、弥漫型1例。术前接受超声检查的EGB患儿(8例,含9个包块),诊断正确率为77.78%。结论超声检查是LCH诊治中重要的一环。首先,高危型多系统受累的LCH患儿,在规范诊治的各个重要时间节点,均应接受详尽的腹部超声检查。其次,甲状腺可能是既往较为忽视的一个器官,建议在高危型LCH患儿随访中可定期进行甲状腺超声筛查,并进一步研究其病变特征。最后,对于儿童颅面部的EGB软组织肿块,超声具有较为特异的诊断价值。Objective To investigate the value of ultrasound in the diagnosis and treatment of Langerhans′cell histiocytosis(LCH)in children.Methods The relevant ultrasound imaging data of children diagnosed as LCH in our hospital were systematically analyzed.Results Ultrasound examination of 71 confirmed cases involved abdominal,thyroid and bone eosinophilic granuloma(EGB)soft tissue masses.There were different degrees of positive characterizations of abdominal organs in 18 children with high-risk multi-system LCH,including 18 cases of liver and bile duct invasion,11 cases of enlarged spleen,15 cases of enlarged abdomen lymph nodes,2 cases of enlarged pancreas,and 3 cases of abdominal effusion.Statistical analysis showed that there was a statistical difference in alkphosphatase index between the biliary tract involvement group and the biliary tract non-involvement group,and its increase indicated biliary tract involvement.Thyroid abnormalities were found in 7 children with multi-system LCH,in which 4 cases with delayed onset,with 5 cases of nodular type,1 case of banded type,and 1 case of diffuse type.Preoperative ultrasound examination of the EGB children(8 cases,including 9 lumps)showed a diagnostic accuracy of 77.78%.Conclusions Ultrasonography is an important part in the diagnosis and treatment of LCH.First of all,children with high-risk multi-system involvement of LCH should receive detailed abdominal ultrasound examination at each time point of standardized diagnosis and treatment processes.Secondly,thyroid may be a neglected organ in the past.It is suggested that thyroid ultrasound screening should be conducted in the follow-up of children with high-risk LCH,and the correlation features should be further studied.Finally,ultrasound has a specific diagnostic value for EGB craniofacial lumps.

关 键 词：朗格汉斯细胞组织细胞增生症 超声 儿童 腹部 甲状腺 骨嗜酸性肉芽肿 

分 类 号：R445.1[医药卫生—影像医学与核医学] R733.3[医药卫生—诊断学]