胆道闭锁53例临床特点与误诊分析

Clinical Features and Misdiagnosis Analysis of Biliary Atresia in 53 Children

目的探讨胆道闭锁(BA)的临床特点与BA误诊原因,以提高其早期诊断率。方法对1995年12月-2010年2月四川大学华西医院收治的53例BA患儿的临床表现及实验室、影像学检查结果进行分析总结,比较其黄疸出现时间与初诊时年龄分布,并分析其彩超、肝胆显像与手术结果的符合率。采用SPSS13.0软件进行统计学分析。结果患儿均出现黄疸,出现肝大32例[60.3%(32/53例)]、TORCH检查结果异常9例[60.0%(9/15例)],伴畸形9例[16.9%(9/53例)。2周龄前出现黄疸31例(58.5%),2周龄后出现黄疸22例(41.5%)。起病时临床误诊为婴儿肝炎综合征16例(30.2%)。46例行腹部彩超检查,其中彩超误诊为先天性胆总管囊肿14例(30.4%)。腹部超声诊断准确率为56.5%(26例)。40例行剖腹探查,均证实为BA,准确率为100.0%。结论黄疸和肝大是BA的主要临床症状。腹部超声检查是诊断BA的重要依据,对于合并TORCH检查结果异常、伴畸形、超声提示胆囊异常病例,应高度警惕BA。

Objective To study the clinical features and the reasons for misdiagnosis of biliary atresia （ BA）, and improve the early diagnosis. Methods The clinical manifestation ,laboratory data and image results of 53 children with BA in West China Hospital, Sichuan University from Dec. 1995 to Feb. 2010 were retrospectively analyzed. Diagnosis time was compared with that of jaundice appeared. The correct diagnosis among the color Doppler ultrasound, hcpatobiliary imaging and surgical findings were also analyzed. SPSS 13.0 software was used to analyze the data. Results All of the cases showed jaundice. Among the patients,32 cases[60.3% （32/53 cases） showed hepatomegaly,9 cases [ 60.0% （9/15 cases） ] were positive TORCH tests, and 9 cases [ 16.90/0 （9/53 cases） had malformation. Of the 53 cases,31 patients （58. 5% ） appeared jaundice before 2 weeks after birth,and 22 patients（41.5%） were more than 2 weeks,and 16 patients（30.2% ） were misdiagnosed as infantile hepatitis syndrome. Of the 46 ultrasound scanned patients, 14 cases（30.4% ） were misdiagnosed as congenital choledochal cyst. The correct diagnosis of BA by ultrasound was 56.5% （26 cases）. Forty patients were diagnosed BA with the findings of surgeries, and the correct diagnosis of BA by surgery was 100.0%. Conclusions Jaundice and hepatomegaly are the main clinical characteristics of BA. Ultrasound scan is an important auxiliary exa-mination to diagnose BA. Positive TORCH tests, malformation and gallbladder morphologic changes suggested strongly a BA diagnosis.