高频超声对胆道闭锁性黄疸及非胆道闭锁性黄疸的鉴别诊断

摘要

Objective To compare the gallbladder morphological features of infant cholestatic jaundice with biliary atresia(BA)or non - biliary atresia(non - BA),and assess the diagnostic value of gallbladder morphological features by high- frequency ultrasonography. Methods Retrospective analysis of high - frequency ultrasonic images of gallbladder morphology was carried out. All this images were obtained from 22 BA( BA group)and 25 non - BA( non - BA group)infants with cholestatic jaundice from 2009 to 2013, in Department of Pediatric Surgery, the Second Hospital of Hebei Medical University. The gallbladder - like structure/ gallbladder lengths and widths between the two groups were compared respectively. Method 1(took 25 mm as the cut - off value of gallbladder - like structure/ gallbladder length)and method 2(took 6 mm as the cut - off value of gallbladder - like structure/ gallbladder width)were employed to differentiate BA group from non -BA group. Results There was no significant difference(P > 0. 05)in age between BA group and non - BA group(P < 0. 05). The BA group exhibited a decreased gallbladder - like structure/ gallbladder length〔(16 ± 8) mm vs. (29 ± 7)mm〕and a decreased width〔(4 ± 2)mm vs. (6 ± 3)mm〕compared with non - BA group. The detection rates of method 1 on BA and non - BA group were 82% (18 / 22)and 88% (22 / 25)respectively. The detection rates of method 2 on BA and non - BA group were 91% (20 / 22)and 56% (14 / 25)respectively. Method 1 showed no significant difference(χ2 = 0. 77,P = 0. 380)in detection rate on BA,but a significantly higher detection rate on non - BA(χ2 = 6. 35,P = 0. 012)when compared with method 2. Conclusion The gallbladder - like structure/ gallbladder length and width in BA infants with cholestatic jaundice are less than those in non - BA infants. High - frequency ultrasonography can clearly display the morphology of gallbladder,has high clinical application value in distinguishing gallbladder - like structure from normall gallbladder structure. Taken 25 mm as cut - off value of gallbladder - like structure/ gallbladder length can differentiate BA form non - BA more effectively.%目的：比较胆道闭锁性黄疸及非胆道闭锁性黄疸患儿的胆囊形态结构特点，高频超声评估胆囊形态结构对黄疸患儿的诊断价值。方法回顾性分析河北医科大学第二医院小儿外科2009—2013年收治的22例胆道闭锁性黄疸患儿（胆道闭锁组）及25例非胆道闭锁性黄疸患儿（非胆道闭锁组）胆囊形态结构的高频超声图像，并比较两组类似胆囊结构/胆囊的长径、前后径。分别应用方法1（以类似胆囊结构/胆囊的长径25 mm 为临界点）及方法2（以类似胆囊结构/胆囊的前后径6 mm 为临界点）对胆道闭锁性黄疸和非胆道闭锁性黄疸进行鉴别。结果胆道闭锁组和非胆道闭锁组患儿就诊日龄比较，差异无统计学意义（ P ＞0.05）；胆道闭锁组较非胆道闭锁组类似胆囊结构 /胆囊的长径〔（16±8）mm 与（29±7mm）〕缩短，类似胆囊结构/胆囊的前后径〔（4±2）mm 与（6±3）mm〕缩短（P ＜0.05）。方法1 对胆道闭锁性黄疸的检出率为82%（18/22），对非胆道闭锁性黄疸的检出率为88%（22/25）；方法2对胆道闭锁性黄疸的检出率为91%（20/22），对非胆道闭锁性黄疸的检出率为56%（14/25）；两种方法对胆道闭锁性黄疸的检出率比较，差异无统计学意义（χ2＝0.77，P ＝0.380）；方法1 对非胆道闭锁性黄疸的检出率高于方法2（χ2＝6.35，P ＝0.012）。结论胆道闭锁性黄疸患儿类似胆囊结构 /胆囊的长径、前后径均小于非胆道闭锁性黄疸患儿。高频超声可以清晰地显示胆囊的形态结构，在区分类似胆囊结构和正常胆囊结构当中有较好的临床价值。以类似胆囊结构/胆囊的长径25 mm 为临界点能更好地鉴别胆道闭锁性黄疸和非胆道闭锁性黄疸。