胆道闭锁的超声诊断

Evaluation of ultrasound diagnosis in biliary atresia

目的:总结并分析20例胆道闭锁患儿的超声图像表现,探讨超声检查对胆道闭锁诊断的临床价值。方法:应用彩色多普勒超声仪观察和记录肝脏及脾脏大小、内部回声;空腹胆囊、餐后胆囊的变化;左右肝管汇合部纤维斑块存在与否。结果:10例左右肝管汇合部可见明显高回声斑块(厚径0.3～0.8cm);3例高回声斑块较小(厚径0.2～0.26cm)。2例胆囊未显示;1例呈条索状,无囊腔;15例胆囊瘪小,胆囊发育及收缩不良;2例胆囊大小、形态正常,但餐后无收缩。全部病例肝脏不同程度增大及肝实质回声粗糙,9例腹腔存在少量积液,14例脾脏增大。结论:左右肝管汇合部纤维斑块具有特异性,可作为胆道闭锁超声诊断的客观指标,胆囊瘪小及收缩不良也具有重要的诊断和鉴别诊断意义。肝脏增大与肝脏回声增强、粗糙程度,及肝纤维化呈正比,可以提示病程长短和预后。

Objective： To summarize and analyse the uhrasonographic findings of 20 infants with biliary atresia （BA）, and to evaluate its diagnostic value. Methods： The color Doppler uhrasonography （US） was performed in 20 infants with BA. The size and echo of liver and spleen, fasting gallbladder and its dynamic change after meal, fibrotic mass in hepatic hilum were observed. Results： The fibrotic mass in hepatic hilum was significantly present in 10 of the 20 infants with BA. Three had small fibrotic mass, 2 had no gallbladder, 1 infant＇s gallbladder had no lumen, 15 had small gallbladder without dynamic change after meal, 2 had the normal size and shape of gallbladder but no contraction after meal. All infants had different degree of hepatomegaly, 9 had small amount of fluid in abdominal cavity, 14 had splenomegaly. Conclusions： The fibrotic mass in hepatic hilum is an objective and specific criterion for diagnosing BA with US. The little gallbladder, especially no contraction function of gallbladder was valuable for diagnosis and differential diagnosis of BA. Hepatomegaly and coarsening of liver parenchyma echogenicity was positively relative with hepatic fibrosis, which may suggest the course and prognosis of BA.