超声检测胆囊和十二指肠液引流检查对婴儿黄疸的鉴别诊断意义

The ultrasonic imaging the gallbladder before and after feeding and determination of bilirubin from duodenal drainage in the differential diagnosis between neonatal hepatitis and biliary atresia.

目的 探讨超声胆囊和十二指肠液引流检查对婴儿持续性黄疸的鉴别诊断意义。方法 应用实时超声仪观察哺乳前后婴儿胆囊大小变化 ,应用婴儿十二指肠引流术收集胆汁。结果 经随访黄疸消退的 30例婴儿肝炎综合征哺乳前胆囊最大断面积为 (2 .0 7± 0 .96 )cm2 ,哺乳后 30min为 (0 .92± 0 .12 )cm2 ,胆囊收缩率为 (5 4 .5± 16 .6 ) % ;十二指肠液胆红素≥12 .5 μmol/L ,胆汁酸阳性。经手术证实的 32例胆道闭锁哺乳前胆囊最大断面积为 (0 .81± 0 .14 )cm2 ,哺乳后 30min为(0 .6 7± 0 .11)cm2 ,胆囊收缩率为 (17.1± 11.5 ) % ,十二指肠液无胆汁。两组胆囊收缩率对比具有极显著性差异 (P <0 .0 1)。结论 超声检测哺乳前后胆囊大小变化及胆囊收缩率结合十二指肠液检查 ,能准确鉴别婴儿肝炎综合征与胆道闭锁。

Objective To investigate the ultrasonic imaging change in the size of the gallbladder before and after feeding and measurement of doodenal bilirubin concentration in the differential diagnosis between neonatal hepatitis and biliary atresia. Methods The size of the gallbladder and before and after feeding of neonatal persistant cholestatic jaundice by B-mode ultrasound. and established a specific duodenal fluid drainage technique. Results The mean largest area of the gallbladder is ( 2.07 ± 0.96 )cm 2 before feeding and ( 0.92 ± 0.12 )cm 2 after feeding and The duodenal fluid bilirubin ≥ 12.5 μmol/L, bile acid tested positive in the 30 cases. The mean bladder contractility is ( 54.5 ± 16.6 )% in IHS group. While in the other 32 cases of which had been confirmed as biliary atresia by operation, the mean largest area of the gallbladder is ( 0.81 ± 0.14 )cm 2 before feeding and ( 0.67 ± 0.11 )cm 2 after feeding and The duodenal fluid bilirubin < 8.5 μmol/L bile acid tested negative. The mean bladder contractility is ( 17.1 ± 11.5 )%. There is significant difference between the two groups (P< 0.01 ). Conclusion The size of gallbladder and its contractility examined by B-mode ultrasound and determination of bilirubin from duodenal drainage are useful in differential diagnosis of neonatal hepatitis and biliary atresia.