高频超声在胆道闭锁诊断中的应用价值

Value of high frequency ultrasonography in biliary atresia

目的探讨高频超声在胆道闭锁(BA)早期诊断中的价值。方法回顾性分析2008年1月至2009年11月37例(行中频超声检查)及2009年12月至2010年12月16例(行高频超声检查)均经手术确诊的BA患儿的术前超声检查资料并进行比较。结果中频超声检查组中提示BA2例(2/37,5.4%);胆囊显示异常25例(25/37,67.6%),其中胆囊腔未显示22例(22/37,59.5%),壁或形态异常2例(2/37,5.4%),小胆囊2例(2/37,5.4%);胆囊腔可显示且未提示异常12例(12/37,32.4%);显示肝门异常高回声2例(2/37,5.4%)。高频超声检查组中,提示BA15例(15/16,93.8%),胆囊均显示异常,其中胆囊腔未显示3例(3/16,18.8%),胆囊壁或形态异常12例(12/16,75.0%),小胆囊1例(1/16,6.3%);胆囊腔可显示且未提示异常1例(1/16,6.3%);TC征(即肝门或左、右肝管汇合部团块状或带状高回声区)阳性14例(14/16,87.5%);提示肝动脉增宽15例(15/16,93.8%)。中频超声对BA的诊断符合率为5.4%(2/37),高频超声对BA的诊断符合率为(93.8%,15/16),两者之间的差异有统计学意义(χ2=40.1,P<0.01)。若将中频超声检查组的胆囊显示异常与肝门显示异常者也诊断为BA,则其诊断符合率(25/37,67.6%)与高频超声检查组的诊断符合率(15/16,93.8%)差异仍有统计学意义(χ2=4.1,P<0.05)。结论高频超声能更清晰地显示肝门结构和胆囊情况,大大提高了对小儿BA的早期诊断率。

Objective To evaluate the value high frequency ultrasonography(HUS)in early diagnosis of biliary atresia(BA).Methods The ultrasonographic results of 37 BA patients between January 2008 and November 2009(MUS group),as well as 16 BA patients during December 2009 to December 2010(HUS group),were collected and analyzed retrospectively.In MUS group,all infants were undergonemidst-frequency ultrasonography(MUS),but HUS was used in HUS group,then the differences of BA diagnosis were analyzed between the two groups.Results The results of MUS group showed as following:only 2(5.4%) cases were given a tendentious diagnosis of BA;25(67.6%)abnormal gallbladders(GBs),including 22(59.5%) cases without shown gallbladder(GB),2(5.4%) GBs with abnormal wall or contour,and 2(5.4%) small GBs with length<1.0 cm,while the other 12(32.4%)cases showed normal GBs;2(5.4%)cases of positive TC sign.The results of HUS group were:15(93.8%) out of 16 cases were given a tendentious diagnosis of BA;15(93.8%) abnormal GBs including 3(18.8%)cases without GB lumen,12(75.0%) GBs with abnormal wall or contour,and 1(6.3%) small GBs;1(6.3%) normal GBs;14(87.5%) cases with positive TC sign;15(93.8%) cases with hypertrophy hepatic artery.The difference for diagnosis of BA between MUS group(5.4%) and HUS group(93.8%)was significant(χ2 =40.1,P<0.01).If the patients with TC sign and abnormal GB were regarded as BA,the diagnostic accordance rate was 67.6%(25/37) in MUS group,which was still statistically different with 93.8%(15/16) in HUS group(χ2 =4.1,P<0.05).Conclusion HUS is more useful to show the features of hepatic portal and GB,which therefore increases the accuracy in early diagnosis of BA.