超声对酒精性肝硬化与肝炎肝硬化的鉴别诊断价值探讨

Discussion on the value of differential diagnosis of ultrasound in alcoholic liver cirrhosis and liver cirrhosis

目的探讨超声对酒精性肝硬化与肝炎肝硬化的鉴别诊断价值,旨在为其临床诊断及治疗提供有利的参考依据。方法选择2016年6月~2017年6月在我院住院和门诊诊断的肝硬化患者68例,其中酒精性肝硬化(ALC)30例,肝炎肝硬化(LC)38例,采用ALOKAα10超声记录左叶厚径、右叶肋下斜径、门静脉内径、脾脏厚度的数值,并观察形态、回声、体积等。结果酒精性肝硬化为小结节性肝硬化,超声表现肝脏体积较大,形态基本正常,86.7%回声呈弥漫性增强。肝炎肝硬化超声表现为粗大不规则的结节,肝脏形态表现异常,50.0%形态不规则,55.3%为不规则回声增强,主要显示为鳞片状、苔藓状或网格状样高回声,50.0%肝被膜为锯齿状。ALC与LC均存在门静脉高压表现,但在腹水方面比较差异不显著(P>0.05)。ALC与LC的肝脏右叶肋下斜径、左叶厚径方面比较,差异具有显著性(P<0.05)。但ALC与LC在门静脉内径、脾脏厚度方面比较,差异不显著(P>0.05)。结论超声对酒精性肝硬化与肝炎肝硬化的诊断与鉴别诊断具有一定的价值。

Objective To investigate the value of ultrasonography in the differential diagnosis of alcoholic liver cirrhosis and liver cirrhosis, in a bid to provide a beneficial references for its clinical diagnosis and treatment. Methods 68 patients with liver cirrhosis who were hospitalized and diagnosed in outpatient clinic in our hospital from June 2016 to June 2017 were selected, including 30 patients with alcoholic liver cirrhosis（ALC）, and 38 patients with liver cirrhosis（LC）. The diameter of the left lobe, the subcostal oblique diameter of right lobe, the diameter of the portal vein and the thickness of the spleen were recorded by ALOKAα10 ultrasound. The morphology, echo, volume were observed in the patients. Results Alcoholic liver cirrhosis was small nodular cirrhosis. Ultrasound performance was larger liver volume,with basically normal shape. 86.7% echo was diffuse enhancement. Liver cirrhosis ultrasound showed coarse and irregular nodules. Liver morphology was abnormal, with 50.0% of irregular shape. 55.3% was irregular echo enhancement. It mainly showed scaly, mossy or grid-like highly enhanced echo. 50.0% of the liver capsule was serrated. ALC and LC showed portal hypertension, but there was no significant difference in ascites（P〉0.05）. There were significant differences in the subcostal oblique diameter of right lobe and the diameter of left lob between ALC and LC（P〈0.05）. However, there was no significant difference between ALC and LC in portal vein diameter and spleen thickness（ P〉0.05）. Conclusion Ultrasound has a certain value in the diagnosis and differential diagnosis of alcoholic cirrhosis and liver cirrhosis.