高频超声探查胆管及胆囊在胆道闭锁和婴儿肝炎综合征鉴别诊断中的价值

Effects of Biliary Duct and Gallbladder High Frequency Ultrasound Imaging in Differential Diagnosis of BA and IHS

目的探讨高频超声探查左右肝管、肝外胆管及胆囊在胆道闭锁(Biliary Atresia,BA)和婴儿肝炎综合征(Infantile Hepatitis Syndrome,IHS)鉴别诊断中的价值。方法使用高频超声对58例持续性阻塞性黄疸患儿进行超声检查,前瞻性地观察左右肝管、肝外胆管上段情况,胆囊大小形态、哺乳后变化(观察至哺乳后2.5 h或至收缩率>50%)及肝门部有无三角形纤维斑块和囊性回声,并与临床诊断或手术结果进行对照。结果 BA 28例:26例左、右肝管及肝外胆管未探及,胆囊表现为4种情况;2例左、右肝管及肝外胆管呈缝隙状,壁毛糙,内透声差;肝门部纤维斑块22例,4例肝门部无纤维斑块的患儿年龄均<3个月;肝门部囊性回声7例。IHS 30例,左、右肝管及肝外胆管均可探及。误诊为胆道闭锁3例,左、右肝管及肝外胆管均呈缝隙状,壁毛糙,内透声差;27例胆囊表现为3种情况;肝门部囊性回声3例。BA与IHS在左、右肝管和肝外胆管是否可见方面差异有统计学意义(P=0.00)。左、右肝管和肝外胆管未探及与肝门部纤维斑块在BA的诊断方面差异有统计学意义(P=0.01),其中年龄<3个月的患儿差异有统计学意义(P=0.01),年龄>3个月的患儿差异无统计学意义(P=1.00)。结论高频探头能够清晰显示婴儿左、右肝管及肝外胆管情况,对早期BA与IHS的鉴别诊断有较高的价值;患儿胆囊收缩率检查建议观察至哺乳后2.5 h。

Objective To investigate the effects of the left and right hepatic duct, extrahepatic biliary duct and gallbladder high frequency ultrasound imaging in diagnosis of BA （Biliary Atresia） and IHS （Infantile Hepatitis Syndrome）. Methods Through examinations of 58 obstructive jaundice infants by high frequency ultrasonography, prospective observations of the ultrasonograms obtained were made on the left and right hepatic duct, the upper extrahepatic biliary duct, the size, morphology and post-breastfeeding changes （until 2.5 h after breast-feeding or the contraction rate〉50%） of gallbladder as well as triangular fibrotic mass and cyst echoes in hepatic hilum. The clinical diagnosis or operation results were taken as the reference so as to make comparisons with the examination results. Results There were 28 cases of BA and 30 IHS. Among 28 patients with BA, the gallbladder of 26 patients were revealed in 4 different conditions without display of the left and right hepatic duct and extrahepatic biliary duct;the crevice-like left and right hepatic duct and extrahepatic biliary duct were found in 2 cases with rough wall and low echo;there were 22 patients with triangular ifbrotic masses in hepatic hilum and 4 （the average age〈3 months） without triangular ifbrotic masses;7 patients were revealed with cyst echo in the hepatic hilum. As for 30 IHS patients, their left and right hepatic ducts and extrahepatic biliary duct were all well displayed：3 patients were misdiagnosed as BA with the features of the crevice-like left and right hepatic ducts and extrahepatic biliary duct, rough wall and low echo;the gallbladder of 27 patients were revealed in 4 different conditions;cyst echo was found in the hepatic hilum in 3 patients. The differences between BA and IHS were of statistical signiifcance （P=0.00） in visualization of the left and right hepatic ducts and the extrahepatic biliary duct. Statistically signiifcant differences （P=0.01） existed between the unrevealed left ＆ right hepatic duct, extrahepatic biliary duct and the triangular ifbrotic mass found in the hepatic in the diagnosis of BA, among which there were statistically signiifcant differences （P=0.01） in patients （age〈3 months） and no statistical signiifcance （P=1.00） in patients （age〉3 months）. Conclusion With clear display of the left＆right hepatic ducts and the extrahepatic biliary duct, the high frequency ultrasound is effective in the early diagnosis of BA and IHS. It is recommended to observe the infants until 2.5 h after breast-feeding so as to obtain the gallbladder contraction rate.