摘要
目的探讨超声测量肝门处囊肿最大宽度鉴别囊肿型胆道闭锁(cystic biliary atresia,CBA)与先天性胆管扩张症(congenital biliary dilatation,CBD)的应用价值。方法回顾性分析2013年1月至2022年1月遵义医科大学附属医院收治的34例年龄小于150 d的肝门处囊肿患儿临床资料,根据术中胆道造影结果分为CBA组和CBD组,比较两组患儿一般情况、生化指标、术前超声特征、术中胆道造影及术中发现。采用受试者操作特征(receiver operating characteristic,ROC)曲线对各项指标诊断CBA的价值进行分析。结果34例肝门囊肿患儿中,CBA组14例,CBD组20例。两组间丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBIL)、直接胆红素(direct bilirubin,DBIL)差异有统计学意义(P<0.05)。ROC曲线结果显示术中测量肝门处囊肿最大宽度的诊断效能最高,其最佳截断值为2.4 cm;ROC曲线下面积(area under the ROC curve,AUC)为0.98,敏感度和特异度分别为91.0%和95.2%;术中测量肝门处囊肿最大长度的最佳截断值为3.1 cm,AUC为0.95,敏感度和特异度分别为91.0%和85.2%。超声测量胆囊宽度的最佳截断值为0.7 cm,AUC为0.95,敏感度和特异度分别为91.0%和89.6%;超声测量肝门处囊肿最大宽度的最佳截断值为2.3 cm,AUC为0.92,敏感度和特异度分别为80.2%和85.9%;超声测量肝门处囊肿最大长度的最佳截断值为3.1 cm,AUC为0.89,敏感度和特异度分别为90.2%和78.8%。结论超声测量肝门处囊肿最大宽度有助于从出生后肝门处存在囊肿的黄疸患儿中诊断出CBA。若超声发现胆囊宽度较小且肝门处囊肿的最大宽度≤2.3 cm,患儿被诊断为CBA的可能性大,需早期进行胆道造影及手术治疗。
Objective To explore the application value of ultrasonic measurement of hilar cyst size in differentiating between cystic biliary atresia(CBA)and congenital biliary dilatation(CBD).Methods Retrospective review was conducted for clinical data of 34 hospitalized children with hilar cysts aged<150 days from January 2013 to January 2022.According to the findings of intraoperative cholangiography,they were assigned into two groups of CBA(n=14)and CBD(n=20).General profiles,biochemical parameters,preoperative ultrasonic characteristics,cholangiographic and intraoperative findings between two groups were compared.And receiver operating characteristic curve(ROC)was plotted for examining the diagnostic value of CBA.Results The serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)and direct bilirubin(DBIL)differed significantly between two groups(P<0.05).ROC results indicated that maximal cyst width had the highest diagnostic efficiency.Optimal cut-off value was 2.4 cm,area under the ROC curve(AUC)0.98 and sensitivity and specificity were 91.0%and 95.2%respectively.Optimal cutoff value of maximal cyst length was 3.1 cm,AUC 0.95 and sensitivity and specificity were 91.0%and 85.2%respectively.Optimal cutoff value for maximal cyst length was 0.7 cm,AUC 0.95 and sensitivity and specificity were 91.0%and 89.6%respectively.Optimal cutoff value of maximum cyst width was 2.3 cm,AUC 0.92 and sensitivity and specificity were 80.2%and 85.9%respectively.Optimal cutoff value of maximum cyst length was 3.1 cm,AUC 0.89 and sensitivity and specificity were 90.2%and 78.8%respectively.Conclusion Ultrasonic measurement of maximal cyst width may aid in diagnosing CBA in jaundiced children with postnatal hilar cyst.If ultrasonic examination reveals that cystic width is≤2.3 cm,CBA highly probable.Early cholangiography and surgery are necessary.
作者
章开智
陈雨彤
郑泽兵
汤成艳
龚元
黄露
周万康
刘远梅
金祝
Zhang Kaizhi;Chen Yutong;Zheng Zebing;Tang Chengyan;Gong Yuan;Huang Lu;Zhou Wankang;Liu Yuanmei;Jin Zhu(Department of Pediatric Surgery,Affiliated Hospital,Zunyi Medical University,Guizhou Provincial Children's Hospital,Zunyi 563000,China)
出处
《临床小儿外科杂志》
CAS
CSCD
2023年第3期218-224,共7页
Journal of Clinical Pediatric Surgery
基金
国家自然科学基金(81760099)
遵市科合HZ字(2019)104号
关键词
胆道闭锁
胆管造影术
外科手术
儿童
Biliary Atresia
Cholangiography
Surgical Procedures,Operative
Child
