CAJ | 학술논문

目的：评价肝门部纤维块( triangular cord sign,TC征)及胆囊异常在胆道闭锁( biliary atresia,BA)诊断中的价值。方法超声检查的黄疸患儿60例经术中胆道造影,47例确诊胆道闭锁,男17例,女30例,年龄7~360d,采用低频及高频超声联合检查。门静脉右支前壁厚度>4mm,即“TC”征阳性；无胆囊或无腔胆囊、小胆囊(长径小于15mm)及胆囊壁不规则或者无胆囊壁结构为胆囊异常；此外还观察肝门部有无扩张的胆管或胆汁湖。以术中胆道造影为金标准,分别以TC征、胆囊异常、TC征与胆囊异常同时出现、TC征或胆囊异常之一出现为超声诊断BA指标,计算敏感度、特异度、阳性预测值、阴性预测值。结果左右肝管及肝外胆管不同程度扩张9例,其中有3例肝外胆管呈囊性扩张,误诊为胆总管囊肿。非BA的全部13例患儿TC征均为阴性,16例BA患儿TC征阴性,31例BA患儿“TC征”阳性。37例胆囊异常被证实为胆道闭锁,包括包括11例无胆囊,4例无腔胆囊,22例胆囊壁异常或者小胆囊。 TC征诊断BA的敏感度、特异度、阳性预测值及阴性预测值分别为66%、100%、100%及45%。胆囊异常诊断BA的敏感度、特异度、阳性预测值及阴性预测值分别为78．7%、84．6%、94．9%及52．4%,TC征与胆囊异常同时出现诊断BA敏感度、特异度、阳性预测值及阴性预测值分别为：53．2%、100%、100%、52%,TC征与胆囊异常之一出现诊断BA敏感度、特异度、阳性预测值及阴性预测值分别为：87．2%、84．6%、95．3%、64．7%。结论 TC征及胆囊异常均为诊断BA的特异度较高的超声诊断指标,二者联合应用可提高诊断敏感度。此外,我们还应重视肝门部“胆汁湖”这一征象,避免误诊。
목적：평개간문부섬유괴( triangular cord sign,TC정)급담낭이상재담도폐쇄( biliary atresia,BA)진단중적개치。방법초성검사적황달환인60례경술중담도조영,47례학진담도폐쇄,남17례,녀30례,년령7~360d,채용저빈급고빈초성연합검사。문정맥우지전벽후도>4mm,즉“TC”정양성；무담낭혹무강담낭、소담낭(장경소우15mm)급담낭벽불규칙혹자무담낭벽결구위담낭이상；차외환관찰간문부유무확장적담관혹담즙호。이술중담도조영위금표준,분별이TC정、담낭이상、TC정여담낭이상동시출현、TC정혹담낭이상지일출현위초성진단BA지표,계산민감도、특이도、양성예측치、음성예측치。결과좌우간관급간외담관불동정도확장9례,기중유3례간외담관정낭성확장,오진위담총관낭종。비BA적전부13례환인TC정균위음성,16례BA환인TC정음성,31례BA환인“TC정”양성。37례담낭이상피증실위담도폐쇄,포괄포괄11례무담낭,4례무강담낭,22례담낭벽이상혹자소담낭。 TC정진단BA적민감도、특이도、양성예측치급음성예측치분별위66%、100%、100%급45%。담낭이상진단BA적민감도、특이도、양성예측치급음성예측치분별위78．7%、84．6%、94．9%급52．4%,TC정여담낭이상동시출현진단BA민감도、특이도、양성예측치급음성예측치분별위：53．2%、100%、100%、52%,TC정여담낭이상지일출현진단BA민감도、특이도、양성예측치급음성예측치분별위：87．2%、84．6%、95．3%、64．7%。결론 TC정급담낭이상균위진단BA적특이도교고적초성진단지표,이자연합응용가제고진단민감도。차외,아문환응중시간문부“담즙호”저일정상,피면오진。
Objective To evaluate the value of triangular cord sign( TC Sign) and abnormal gallbladder on ultrasound im-ages in the diagnosis of biliary atresia ( BA) , with surgery and Pathology as the reference standard. Methods Infants with choles-tatic jaundice were examined by sonography. Of them, 60 infants performed the intraoperative cholangiography and 47 infants was confirmed with BA. The ultrasund examinations focused on the visualization of the triangular cord sign and assessment of abnormal gallbladder. Thickness of the echogenic anterior wall of the right portal vein ( EARPV) was measured. The TC sign was defined as thickness of the EARPV of more than 4 mm. Abnormal gallbladder contained no gallbladder in the area of calot triangle or the gall-bladder without lumen, small gallbladder with length less than 15mm and irregular gallbladder wall. Sensitivity, specificity, positive and negative predictive values were calculated for TC Sign,abnormal gallbladder, concurrence of TC Sign and abnormal gallbladder, and TC Sign and abnormal gallbladder conbined. Results Right-and-left hepatic duct and porta hepatis bile duct was dilated in 9infants. choledochal cyst co-existed with biliary atresia in 3 (3/9)infants and the misdiagnosis was that of choledochal cyst. The Tri-angular cord (TC)sign was present in 31of47infants with BA and was not appeared in 16 infants with BA. Abnormal gallbladder pres-ented in 37 of 47 infants was confirmed BA, Including 11 infants without gallbladder, 4 infants’ gallbladder without lumen, 22 in-fants with small gallbladder or abnormal gallbladder wall. Sensitivity, specificity, and positive and negative predictive values of TC Sign were 66%, 100%,100% and 45%. Abnormal gallbladder had 78. 7% sensitivity, 84. 6% specificity, 94. 9% and 52. 4% pos-itive and negative predictive values respectively. Concurrence of TC Sign and abnormal gallbladder was in a sensitivity of 53. 2%, specificity of 100%,and positive and negative predictive values of 100% and 52. 4% for the diagnosis of BA. TC Sign and abnormal gallbladder conbined had 87. 2% sensitivity, 84. 6% specificity, 95. 3% and 64. 7% positive and negative predictive values respec-tively. Conclusion TC Sign and abnormal gallbladder on ultrasound images are high specificity in the diagnosis of biliary atresia, TC Sign and abnormal gallbladder conbined can improve the sensitivity for the diagnosis of biliary atresia. In addition, we should attached great importance to the presence of biliary lake in the area of the hepatic portal system, and avoided misdignosis.