高频超声测量正常儿童胆总管直径的临床研究

Measurement of common bile duct in healthy children with high-frequency ultrasonography

目的目前国内外尚缺乏超声下不同年龄段儿童胆总管直径正常参考值的大样本统计数据报道，先天性胆管扩张症的诊断标准比较模糊。应用高频超声测量正常不同年龄段小儿胆总管直径，确定其正常值参考范围。方法入选标准：①年龄≤14周岁；②无肝胆疾病病史，无黄疸体征，其他辅助检查证实无胆道系统疾病。应用超声测量343例1个月～14岁（平均年龄3．2岁，中位年龄2．8岁）小儿正常胆总管直径，记录一般临床资料（如性别、年龄等），以及超声测量胆总管直径数据。结果343例小儿中322例胆总管显示清晰，胆总管显示率为93．9％。322例小儿平均胆总管直径为（1．58±0．70）mm，所有儿童中胆总管直径均≤4．4mm（变化范围0．4～4．4mm）。多元线性回归分析显示，年龄是胆总管直径的独立影响因素（t=12．494，P〈0．0001）。直线相关（Spearman）分析显示，年龄与胆总管直径呈线性相关（r=0．573，P〈0．001）。p-p图显示胆总管直径在不同年龄段的分布为非正态分布，因此采用百分位数法确定参考值范围，参考值范围为单侧。我们得出各年龄段小儿正常胆总管参考值分别为：≤1岁为≤2．26mm；≤4岁为≤2．99mm；≤7岁为≤3．03mm；≤14岁为≤4．10mm。结论儿童胆总管直径随年龄增长而增长，初步得出各年龄段小儿正常胆总管参考值分别为：≤1岁为≤2．26mm；≤4岁为≤2．99mm；≤7岁为≤3．03mm；≤14岁为≤4．10mm。超过此参考值范围应该视为胆总管扩张。

Objective To measure the diameter of the common bile duct （CBD） in healthy children with different ages using high-frequency uhrasonography. Methods A total of 343 healthy children without any clinical or laboratory evidence for biliary, hepatocellular or pancreatic disease were recruited in this study. Their ages ranged from i month to 14 years old （mean age： 3. 2 years, median age： 2. 8 years）. The diameter of their CBD was determined using realtime high-resolution ultrasonography. Results Among the 343 children, the CBD of 322 were clearly detected and measured （93. 9%）. The mean CBD diameter of the 322 children was 1.58 ＋ 0. 70 ram. The CBD diameter ranged from 0. 4 to 4. 4 mm. Multiple linear regression analysis showed the age was the only independent risk factors associated with the diameter of CBD （t = 12. 494,P〈0. 0001 ）. Spearman correlation analysis revealed the diameter of CBD was positively correlated with age （r = 0. 573, P〈0. 001）. P-P diagrams suggested the diameter of CBD were not normally distributed. Based on these statistic analysis, the reference diameter of CBD in healthy children was less than 2. 26 mm in children younger than 1 year old, 2. 99 mm in children younger than 4 years old, 3.03 mm in children younger than 7 years old, and 4. 10 mm in children younger than 13 years old. Conclusions The diameter of the CBD is increasing with age in healthy children.