婴儿胆道闭锁与肝炎超声影像特征分析

Ultrasound differential diagnosis of infantile hepatitis and biliary atresia

目的分析婴儿胆道闭锁与肝炎超声影像特征。方法回顾性分析我院2016年6月至2019年10月38例手术证实为胆道闭锁(biliaryatresia,BA)的术前超声声像图及26例出院诊断为婴儿肝炎(infant hepatitis,IHS)的超声声像图特点。结果术后病理检查证实为BA患儿38例,年龄31天至90天,IHS患儿26例,年龄19天至8个月。两组患儿中,BA组患儿胆囊结构多为异常表现,IHS患儿多为正常表现,差异有统计学意义(P<0.05);两组患儿哺乳前、后胆囊大小比较,差异有统计学意义(P<0.05);胆囊收缩率比较,差异具有统计学意义(P<0.05)。两组患儿胆囊长径、肝动脉内径、胆总管外径比较,差异有统计学意义(P<0.05)。38例BA患儿中,28例超声影像显示胆总管外径增宽并呈低回声改变,无其他异常,26例IHS患儿中24例胆总管外径未见增宽及低回声改变,CDFI均可见淋巴门彩色血流信号。38例BA患儿中29例可见左右肝管汇合处管腔闭合呈纤维条索状,3例有肝门部囊肿,其余结构正常;26例HIS患儿肝门部均有管状结构。35例BA患儿肝脏汇管区水肿(格林森鞘增宽),其余3例患儿未见水肿;HIS患儿中有5例格林森鞘增宽,其余患儿肝内血管壁回声增强。38例BA患儿均有不同程度的肝大;HIS患儿中有15例肝稍大。结论超声检查可作为婴儿BA与IHS鉴别诊断的首选检查方法。

Objective Analysis of ultrasound imaging features of biliary atresia and hepatitis in infants.Methods Retrospective analysis of the preoperative sonographic features of 38 cases of biliary atresia(BA)confirmed by surgery in our hospital from June 2016 to October 2019 and 26 cases of infant hepatitis(IHS)discharged from hospital Image analysis for comparison.Results Thirty-eight children were confirmed by pathology after operation,aged 31 d to 90 d.Twenty-six IHS children aged 19 d to 8 months.Of the two groups,the gallbladder structure of the children in the BA group was mostly abnormal,IHS the children were mostly normal,and the difference was statistically significant(P<0.05).Comparison of gallbladder size between the two groups was statistically significant(P<0.05).Compared gallbladder shrinkage rate,the difference was statistically significant(P<0.05).Based on the ultrasound The image showed that the outer diameter of the common bile duct was widened and hypoechoic in 28 of the 38 BA children,but there were no other abnormalities.In 24 of the 26 IHS children,the outer diameter of the common bile duct was not widened and hypoechoic,and the color blood flow signal of the lymphatic portal was CDFI.Of the 38 children BA 29 showed that the lumen closure at the confluence of left and right hepatic ducts was fibrous stripe-like,3 had hepatic portal cysts,and the rest had normal structure;26 HIS had tubular structure at the hepatic portal.There were 35 BA cases of edema in the catchment area of the liver(widening of the Greenson sheath)and no edema in the other 3 cases;5 of the HIS cases showed widening of the Greenson sheath.The echo of the vascular wall in the liver was enhanced in the rest of the children.All the 38 children with BA had different degree of liver enlargement.Fifteen of HIS children had slightly larger livers.Conclusion Ultrasonography has the advantages of convenience,good visualization,strong reproducibility,and dynamics.It can be used as the first choice for the differential diagnosis of BA and IHS.