肝门部胆管声像在鉴别婴儿肝炎综合征与胆道闭锁中的应用价值

Identification of biliary atresia and infantile hepatitis syndrome by hilar bile duct usingultrasonography

目的探讨肝门部胆管声像在鉴别胆道闭锁(BA)与婴儿肝炎综合征(IHS)中的应用价值。方法回顾分析BA与IHS患儿的超声声像资料,比较两组肝门部胆管声像:管腔显示率、三角带征(TC征)阳性率两项指标。结果两组患儿肝门部胆管管腔显示率、TC征阳性率及联合肝门部胆管管腔显示率+TC征阳性率相比较,差异均有统计学意义(P<0.05);BA组肝门部胆管管腔显示率(23.5%)显著低于IHS组(90.9%);BA组TC征阳性率(41.2%)显著高于IHS组(0);BA组肝门部胆管管腔显示不清+TC征阳性率为41.2%,而IHS组为0;IHS组肝门部胆管管腔显示清晰+TC征阴率为90.9%,而BA组为29.4%。结论肝门部胆管管腔显示情况对鉴别BA与IHS具有重要价值,而肝门部胆管管腔联合TC征显示情况可进一步鉴别两者。

Objective To investigate the clinical value of uhrasonographic（US） features of hilar bile duct in dif- ferentiation between biliary atresia（BA） and infantile hepatitis syndrome（IHS）. Methods US images of hilar bile duct of 17 infants with BA and 33 infants with IHS were reviewed. Two US features including the display of hilar biliary lumen and the triangular cord （TC） sign were assessed. Results The display of hilar biliary lumen, the positive rate of the tri- angular cord sign, as well as their combination showed a significant difference between BA and IHS groups （ P 〈 0. 05 ）. The display rate of the hilar biliary lumen in BA infants was lower than that in IHS infants. The display rate of the hilar biliary lumen was 4/17（23.5% ） in BA, and 30/33（90. 9% ） in IHS. The positive rate of the TC sign in BA infants was higher than that in IHS infants. The positive rate of the TC sign was 7/17（41.2% ） in BA, and 0/33（0） in IHS. There were 7 in 17 infants （41.2%） with poor display of hilar biliary lumen and positive TC sign in BA, whereas the proportion was 0 in IHS. While there were 30 in 33 infants （90. 9% ） with clear display of bilar biliary lumen and negative TC sign in IHS, whereas the proportion was 29.4% （5/17） in IHS. Conclusion Observation of lumen of hilar bile duct has great value in differentiation between BA and IHS. The display of hilar biliary lumen coupled with TC sign might be used to further differentiate BA from IHS.