CAJ | 학술논문

目的回顾手术确诊非胆道闭锁和胆道闭锁两组病例的临床资料,分析胆道闭锁疑似病例的临床特征和术前疑诊为胆道闭锁的原因.方法收集2004年至2010年本院术前拟诊为胆道闭锁而行腹腔镜或开腹胆道造影的602例患儿的临床资料,依据术中胆道造影的诊断结果分为非胆道闭锁组和胆道闭锁组.分析近年非胆道闭锁病例所占比例,对照两组患儿黄疸发生日龄、肝功能及B型超声结果.计算同位素肝胆排泄性造影诊断胆道闭锁的阳性预测值及假阳性率,以及非胆道闭锁病例的疾病构成.结果非胆道闭锁组83例,胆道闭锁组519例.近年行手术探查的所有患儿中非胆道闭锁比例无明显下降.两组出现黄疸的日龄、入院TBIL(169.9 mmol/L比172.3 mmol/L,P＞0.05)、DBIL(128.7 mmol/L比132.5 mmol/L,P＞0.05)、DBIL/TBIL(0.76比0.77,P＞0.05)、ALT(141.3 mmol/L比114.9 mmol/L,P＞0.05)比较均无统计学差异.γ-GT非胆道闭锁组显著低于胆道闭锁组(263.2 mmol/L比902.7 mmol/L,P＜0.01),B型超声检查肝脏肋下大小,非胆道闭锁组小于胆道闭锁组(2.99比3.61,P＜0.01).同位素肝胆排泄性造影阳性患儿共498例,其中术后诊断为非胆道闭锁患儿66例,假阳性率为13.3％.83例非胆道闭锁组包括:婴儿肝炎综合征58例,胆道发育不良16例,TPN相关性胆汁淤积症5例,胆道穿孔和浓缩胆栓综合征各2例.结论肝功能检查的相似性及过度依赖同位素肝胆排泄性造影可能是非胆道闭锁患儿疑诊为胆道闭锁的主要原因,术前仔细分析黄疸出现的日龄、γ-GT、B型超声检查肝脏大小有利于非胆道闭锁病例术前的鉴别诊断.
목적 회고수술학진비담도폐쇄화담도폐쇄량조병례적림상자료,분석담도폐쇄의사병례적림상특정화술전의진위담도폐쇄적원인.방법 수집2004년지2010년본원술전의진위담도폐쇄이행복강경혹개복담도조영적602례환인적림상자료,의거술중담도조영적진단결과분위비담도폐쇄조화담도폐쇄조.분석근년비담도폐쇄병례소점비례,대조량조환인황달발생일령、간공능급B형초성결과.계산동위소간담배설성조영진단담도폐쇄적양성예측치급가양성솔,이급비담도폐쇄병례적질병구성.결과 비담도폐쇄조83례,담도폐쇄조519례.근년행수술탐사적소유환인중비담도폐쇄비례무명현하강.량조출현황달적일령、입원TBIL(169.9 mmol/L비172.3 mmol/L,P＞0.05)、DBIL(128.7 mmol/L비132.5 mmol/L,P＞0.05)、DBIL/TBIL(0.76비0.77,P＞0.05)、ALT(141.3 mmol/L비114.9 mmol/L,P＞0.05)비교균무통계학차이.γ-GT비담도폐쇄조현저저우담도폐쇄조(263.2 mmol/L비902.7 mmol/L,P＜0.01),B형초성검사간장륵하대소,비담도폐쇄조소우담도폐쇄조(2.99비3.61,P＜0.01).동위소간담배설성조영양성환인공498례,기중술후진단위비담도폐쇄환인66례,가양성솔위13.3％.83례비담도폐쇄조포괄:영인간염종합정58례,담도발육불량16례,TPN상관성담즙어적증5례,담도천공화농축담전종합정각2례.결론 간공능검사적상사성급과도의뢰동위소간담배설성조영가능시비담도폐쇄환인의진위담도폐쇄적주요원인,술전자세분석황달출현적일령、γ-GT、B형초성검사간장대소유리우비담도폐쇄병례술전적감별진단.
Objective To analyse the clinical features and causes of misdiagnosis of biliary atresia in a retrospective study.Methods Six hundred and two infants who were suspected to have biliary atresia were recruited into our study from 2004 to 2010.All cases were divided into non-biliary atresia group and biliary atresia group according to intraoperative cholangiography findings.The annual proportion of patients was calculated,while the time of the occurrence of juandice,liver function and ultrasound results in two groups were compared.Moreover,the positive predictive value and false positive rate of hepatobiliary scintigraphy in biliary atresia were calculated.In addition,the disease spectrum of non-biliary atresia group patients was analysed.Results In the 602 cases,83 patients were diagnosed to be in non-biliary atresia group.The remaining 519 cases were comfirmed to have biliary atresia.There was no significant decline in the proportion of non-biliary atresia in all cases by years.Time of the occurrence of jaundice,TBIL(169.9 mmol/L vs 172.3 mmol/L,P0.05),DBIL(128.7mmol/L vs 132.5 mmol/L,P＞0.05),DBIL/TBIL(0.76 vs 0.77,P＞0.05)and ALT(141.3 mmol/L vs 114.9 mmol/L,P＞0.05)values before cholangiography showed no statistically significant difference between these two groups.However,the mean level of γ-GT was 263.2 mmol/l in non-biliary atresia group while 902.7 mmol/l in biliary atresia group(P＜0.01).The liver size below the costal margin detected with ultrasound was smaller in non-biliary atresia group than that in biliary atresia group(2.99 cm and 3.61 cm respectively,P＜0.05).Among the 498 infants who received hepatobiliary scintigraphy examination,the false positive rate was 13.3％(66/498)and the positive predictive value was 86.7％(432/498).In the non-biliary atresia group,58 infants suffered from hepatitis syndrome,16 cases were biliary dysplasia,5 cases were TPN related cholestasis,two cases were bile duct perforation and two were Bile-Plug Syndrome.Conclusions The similarity of liver function tests and excessive dependence on hepatobiliary scintigraphy examination might cause the misdiagnosis of patients with jaundice.The time of jaundice occurrence,the level of γ-GT and liver size below the costal in the ultrasound are helpful in diagnosis for these jaundice infants.