肝内胆管错构瘤在出入境人员中的超声诊断价值与漏误诊分析

The value of ultrasonography in the diagnosis of intrahepatic bile duct hamartoma in entry-exit personnel and analysis of missed and misdiagnosis

探讨体检超声对肝内胆管错构瘤(IBDH)的诊断价值,并分析漏误诊原因。方法回顾性分析体检超声筛查并经核磁共振成像(MRI)确诊为(IBDH)9例患者的声像图表现,总结(IBDH)的常规超声特点及漏误诊的主要原因。结果IBDH的典型超声表现为:1.微小厚壁囊肿,形态可不规则2.多发高回声微小结节伴肝脏实质回声增粗;3.多发小高回声及低回声结节,部分其旁可见“彗星尾征”。9例患者中,仅有4例超声首诊为IBDH,其余5例属于误诊情况,3例被误诊为肝内多发小囊肿(33.33%),2例被误诊为肝内弥漫性病变(22.22%)。超声首诊检出率(44.44%)。结论有研究认为IBDH有可能通过化生、不典型增生而癌变,因此,体检超声检查对诊断肝内胆管错构瘤具有一定的诊断价值,但需要与肝血管瘤、肝硬化结节、肝囊肿等常见疾病进行鉴别诊断。

To investigate the diagnostic value of physical examination ultrasound for intrahepatic bile duct hamartoma(IBDH),and analyze the causes of misdiagnosis and misdiagnosis.Methods The ultrasonographic features of 9 patients with IBDH diagnosed by MRI were retrospectively analyzed.The conventional ultrasonographic features of IBDH and the main causes of misdiagnosis and misdiagnosis were summarized.Results The typical ultrasonographic findings of IBDH were as follows:1.Small thick-walled cyst with irregular morphology 2.Multiple hyperechoic micronodules with echogenic thickening of liver parenchyma;3.Multiple small hyperechoic and hypoechoic nodules with“comet tail sign”adjacent to some of the 9 patients,only 4 cases were first diagnosed as IBDH by ultrasound,and the remaining 5 cases were misdiagnosed,3 cases were misdiagnosed as multiple small intrahepatic cysts(33.33%),and 2 cases were misdiagnosed as intrahepatic diffuse lesions(22.22%).The first detection rate of ultrasound was 44.44%.Conclusions Some studies suggest that IBDH may be carcinogenic through metaplasia and atypical hyperplasia.Therefore,physical examination ultrasound has certain diagnostic value in the diagnosis of IBDH,but it needs to be differentiated from hepatic hemangioma,liver cirrhosis nodules,liver cyst and other common diseases.