彩色多普勒超声在胆道闭锁患儿肝硬化诊断中的价值

Value of color Doppler ultrasonography in the diagnosis of liver cirrhosis in infants with biliary atresia

目的探讨彩色多普勒超声在胆道闭锁患儿肝硬化诊断中的价值,寻找可靠的超声形态学与血流动力学参数。方法选取2014年1月至2017年4月广州市妇女儿童医疗中心行胆道造影+肝活检术或胆道造影+Kasai手术+肝活检术的胆道闭锁患儿93例。结合术中肝脏标本病理学检查结果,依据肝脏纤维化Ohkuma′s分级标准,将患儿分为肝硬化组(4级)21例和非肝硬化组(0～3级)72例。回顾性分析和比较2组患儿术前腹部彩色多普勒超声检查资料:肝实质回声、肝缘情况、肝表面、脾长径、肝动脉最大截面直径(HAD)、肝动脉峰值流速(HAVmax)、肝动脉阻力指数(HARI)、门静脉主干最大截面直径(PVD),有无腹水、脐静脉有无重开情况。结果 21例肝硬化组患儿均表现为肝实质回声增粗增强、肝缘变钝、肝表面呈波浪状改变以及出现腹水,14例出现脐静脉重开,各超声征象所占比例均显著高于非肝硬化组,差异均有统计学意义(χ2=73.78、69.90、93.04、62.97、56.51,P均<0.01);肝硬化组脾长径、HAD、HAVmax、HARI均显著高于非肝硬化组,差异有统计学意义(t=13.972、2.984、5.643、6.930,P均<0.01);2组患儿PVD比较,差异无统计学意义(t=0.516,P> 0.05)。结论脾大、肝实质回声增强增粗、肝缘变钝、肝表面呈波浪状改变、肝动脉增宽,HARI、HAVmax增高,以及腹水、脐静脉重开对诊断胆道闭锁患儿肝硬化具有重要价值。

Objective To evaluate the value of color Doppler ultrasonography in the diagnosis of liver cirrhosis in infants with biliary atresia(BA),and to identify the reliable ultrasound parameters on morphology and hemodynamics.Methods From January2014to April2017,93BA infants who underwent intraoperative cholangilgraphy and liver biopsy or intraoperative cholangilgraphy,Kasai procedure and liver biopsy in the Women and Children′s Medical Center of Guangzhou were retrospectively analyzed.The hepatic fibrosis was graded using Ohkuma′s grading criteria,by which the total of93BA patients were divided into the cirrhosis group(grade4)and the non-cirrhosis group(grade0~grade3)according to the results of pathological examination.The preoperative ultrasound data including echotexture of hepatic parenchyma,liver edge,hepatic capsule,splenic diameter,diameter of hepatic artery(HAD),maximum velocity of hepatic artery(HAVmax),resistance index of hepatic artery(HARI),diameter of portal vein(PVD),ascites and reopening of umbilical vein were analyzed retrospectively and compared between the two groups.Results Ninety-three infants were divided into21of cirrhosis group and72of non-cirrhosis group.In the cirrhosis group,21infants presented as thickened and enhanced echotexture of liver parenchyma,blunt hepatic margins,wavelike hepatic capsule and ascites;14appeared reopening of umbilical vein,significantly higher than those of the non-cirrhosis group,the differences were significant(χ^2=73.78,69.90,93.04,62.97,56.51,all P<0.01).The splenic diameter,HAD,HAVmax,HARI in cirrhosis group were significantly higher than those in the non-cirrhosis group,the differences were significant(t=13.972,2.984,5.643,6.930,all P<0.01).There was no significant difference in PVD between the two groups(t=0.516,P>0.05).Conclusions The degree of splenomegaly,thickened and enhanced echotexture of liver parenchyma,blunt hepatic margins,wave-like hepatic capsule,enlarged HAD,heighten of HARI,enhanced HAVmax,ascites and reopening of umbilical vein are important factors for the diagnosis of hepatic cirrhosis in the patients with BA.