高频彩色多普勒超声和核素肝胆动态显像对胆道闭锁早期诊断价值的对比研究

Comparison of high-frequency color Doppler ultrasonography and hepatobiliary seintigraphy in early diagnosis of biliary atresia

目的探讨高频彩色多普勒超声和核素肝胆动态显像在胆道闭锁早期诊断中的临床价值。方法选取因梗阻性黄疸在我院小儿外科手术治疗的患儿56例,术前行常规高频彩色多普勒超声检查、核素肝胆动态显像,胆道闭锁诊断的金标准为术中胆道造影和病理检查结果,计算敏感度、特异度、准确度、阳性预测值、阴性预测值。结果56例梗阻性黄疸患儿(男32例,女24例),其中胆道闭锁34例(60.7%),非胆道闭锁22例(39.3%),高频彩色多普勒超声诊断胆道闭锁的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为88.2%、77.3%、83.9%、85.7%、81.0%;核素肝胆动态显像诊断胆道闭锁的敏感度、特异度、准确度、阳性预测值、阴性预测值100.0%、63.6%、85.7%、81.0%、100.0%。结论高频彩色多普勒超声诊断胆道闭锁的特异性高,核素肝胆动态显像诊断胆道闭锁的敏感度高,两种检查方法结合能够较为准确的对胆道闭锁及其他原因引起的婴幼儿黄疸进行诊断和鉴别诊断,可以提高胆道闭锁的早期诊断率,减少不必要的手术探查,改善临床预后。

Objective To analyze the diagnostic value of high-frequency color Doppler ultrasonography and hepatobiliary seintigraphy in early diagnosis of biliary atresia.Methods The study involved 56 neonates and infants with cholestatic jaundice who were confirmed with cholangiography by operation or abdominoscopy.Preoperative high-frequency color Doppler ultrasonography and hepatobiliary seintigraphy were performed.Two diagnostic methods were compared with the gold standards.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were calculated.Results In 56 consecutive cholestatic infants（32boys,24girs）,there were 34 infants with biliary atresia（60.7%）and 22 infants with non-biliary atresia（39.3%）.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of biliary atresia diagnosis by high-frequency color Doppler ultrasonography were 88.2%,77.3%,83.93%,85.71%,80.95%,and those of biliary atresia diagnosis by hepatobiliary seintigraphy were 100.0%,63.6%,85.7%,81.0% and 100.0%,respectively.Conclusion High-frequency color Doppler ultrasonography diagnosis of biliary atresia with high specificity,superior to that of hepatobiliary seintigraphy;Hepatobiliary seintigraphy diagnosis of biliary atresia with high sensitivity,superior to that of high-frequency color Doppler ultrasonography.The combination of two methos can distinguish between biliary atresia and other causes of neonates and infants cholestasis with high accuracy,and unnecessary surgery may be avoided,improved clinic prognostic.