影响胆道闭锁早期诊治的原因分析

Factors affect an early diagnosis of biliary atresia

目的 分析影响胆道闭锁早期诊断和治疗的因素并探讨解决对策。方法 回顾性总结与分析 70例胆道闭锁患儿就诊年龄与临床表现、主诊医生和家长对本病的认识、影像学检查结果等方面对早期诊断的影响 ,探讨延误诊治的各种原因。结果 影像学检查中 ,肝胆核素检查 2 7例 ,6例误诊。B超检查在未掌握观察肝门纤维块前 ,2 3例中仅有 14例诊断正确 ,而在掌握该方法后 ,检查38例 ,35例诊断正确。结论 先天性胆道闭锁延误诊治的原因有 :临床表现不典型、观察病情不细致、主诊医生对本病的认识不足、影像学检查的误诊等。因此建议 :仔细体检 ,医生亲自观察大便颜色 ;B超检查内容包括观察肝门纤维块和胆囊进食前后的变化 ;肝胆核素检查 ,应防止放射物污染 ,减少同位素在体内的分解水化。

Objective To analyze the factors affect early diagnosis of biliary atresia.Methods The factors leading to delay in diagnosis or misdiagnosis were analyzed in 70 patients.Results Of 70 patients who were admitted for more than 10 days, 24 patients were operated on. 27 patients had HIDA scan with 6 being misdiagnosed. Of 23 patients who had ultrasound study, only 14 had the right diagnosis. After improvement in ultrasonography skill, 35 out of 38 patients were diagnosed correctly.Conclusions The causes of misdiagnosis of biliary atresia include very young children, atypical clinical presentation, errors of imaging studies and careless clinical examination. Therefore one should inspect the color of stool personally, look for fibrotic portal mass and gallbladder change on ultrasonography and take a comprehensive consideration in HIDA scan results.