超声引导经皮肝穿在婴儿肝炎综合征诊断中的临床应用价值

Percutaneous liver biopsy guided by ultrasound in infant hepatic syndrome

目的探讨超声引导经皮肝穿活检在婴儿肝炎综合征(IHS)的应用价值。方法按全国小儿病毒性肝炎防治座谈会制定的标准诊断为IHS的患儿37例,全部病例有黄疸、肝大或肝脾大及肝功能损害。在超声引导下使用自动活检枪弹射18G配枪用槽式切割活检针,彩超引导避开肝内血管及胆管、胆囊等重要结构,肝组织标本采用HE染色及马松染色。结果IHS主要病理特征以肝纤维结缔组织增生最常见,其他依次为肝细胞水变性、肝细胞点状、灶性坏死、碎片状坏死、淤胆、巨细胞形成、肝小叶结构紊乱等;37例中35例存在不同程度肝纤维化,年龄≤6个月29例,其中S17例,S24例,S311例,S413例。结论采用实时超声引导下婴儿经皮肝组织自动活检术是一项安全、快速、成功率高、并发症少的技术,能为婴儿这一特殊年龄组肝脏疾病的诊断提供更多更新的信息。

Objective To explore the application value of percutaneous liver biopsy guided by ultrasound in infants with infant hepatitis syndrome （IHS）. Methods Percutaneous liver biopsy guided by ultrasound was carried out in 37 clinical diagnosed infants with IHS. All the infants were presented with jaundice, hepatomegaly, splenomegaly or liver function damage. Color Doppler ultrasonography was performed to avoid the injure of the blood vessel and bile duct during the procedure, the biopsy specimens were stained with routine hematoxylin and eosin （HE） or special dyed method for fibrosis such as Masson trichrome. Results The main histological features of IHS were hepatic fibrosis, followed by hepatocyte watery degeneration, punctuate, dotted and piecemeal necrosis, bile plugs, accumulation of macrophage, structure disorders of liver lobules. 35 cases among the 37 IHS existed the different stages of fibrosis： 7 cases of stage 1 （SI） , 4 of S2, 11 of S3, and 11 of S4. Conclusion The teehnique of pereutaneous automatie biopsy guided by ultrasound is a safe, rapid and effeetive method with high sueeessful rate and low eomplieation rate, the aeeurate rate for diagnosis of liver diseases was remarkably improved through this method, and thus deserved to be used elinieally and broadly.