高频超声对婴儿胆道闭锁的鉴别诊断价值探讨

摘要

目的 应用高频超声对黄疸婴儿进行检查,评价其对胆道闭锁(BA)患儿的鉴别诊断价值.方法 43例黄疸患儿空腹4h后进行常规腹部超声和高频超声检查,记录每例患儿的肝脏、胆囊、胆管、肝右动脉、门静脉及TC (triangular cord)征的情况等,并初步诊断是否为胆道闭锁.同时收集患儿的各项化验结果,MRI、CT等影像资料,手术所见和肝穿组织学及术后病理报告.结果 以肝穿组织学及术后病理检查结果为金标准,高频超声正确诊断18例BA中的17例,并且25例非BA均未被误诊.TC征阳性,肝右动脉增宽,胆囊异常(无胆囊、胆囊壁异常或(和)形态异常)三者对诊断胆道闭锁具都有很高的价值.以TC征阳性诊断BA的敏感性,特异性及准确性分别为:88.9％、100％、95.3％；如以肝右动脉内径＞0.16 cm为诊断BA的理想截断值,其敏感性、特异性及准确性分别为:94％、84％、88.4％；以胆囊异常诊断BA的敏感性,特异性及准确性分别为:94％、100％、97.7％.综合考虑以上三者,诊断BA的敏感性、特异性及准确性分别为:94％、100％、97.7％.结论 高频超声通过清晰地显示肝门部的形态结构,显著提高超声对婴儿胆道闭锁诊断的准确性,其准确率为97.7％ (42/43).%Objective The infants with jaundice were explored by high-frequency ultrasonography (US) to evaluate its differential diagnostic value in biliary atresia(BA). Methods After 4Hr fasting, 43 infants with neonatal jaundice were scaned with general and high-frequency US respectively. The data of liver, gallbladder, bile duct* right hepatic Artery (RHA) , portal vein(PV) and triangular cord (TO sign were observed and measured, and then a primary BA diagnosis was given. At the same time, other data were collected including the laboratory examinations, MRI or CT, operation and pathology. Results The results of the liver puncture biopsy and pathology after operation were regarded as gold standard. 17 of 18 BA patients were diagnosed by the high-frequency US. And no non-BA was misdiagnosed. The positive TC sign, hypertrophy RHA and abnormal gallbladder (absence of gallbladder, lack of smooth wall or with irregular contour) emphasized their importance in diagnosis of BA. The TC sign had 88. 9% sensitivity, 100% specificity, and 95. 3% accuracy in detection of BA. If we regarded RHA>0. 16 cm as the best cut-off value, sensitivity, specificity and accuracy were 94%,84% and 88. 4% respectively. The sensitivity, specificity, and accuracy for diagnosis BA of abnormal of gallbladder wall or shape were 94% , 100% , 97. 7% respectively. By combining the three features, it displayed a sensitivity with 94% ,a specificity with 100% and a accuracy with 97. 7%. Conclusions High-frequency US is useful to clearly display the features of hepatic portal. These features increase the diagnostic accuracy of BA to 97. 7%(42/43).