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上海医科大学儿科医院传染科自1991年10月～1997年2月共收治小儿病毒性肝炎745例,其中6例入院后确诊为先天性胆道畸形,为同期误诊率最高的病种,本文就其误诊原因分析如下。 1 临床资料 6例中男4例,女2例;年龄46天～5 4/12岁。病程12～30天;入院后纠正诊断时间2～5天。先天性胆道畸形有与病毒性肝炎相似的临床表现:有胃肠道症状6例(纳差、恶心、呕吐),尿色加深并呈浓茶水样;腹痛2例;皮肤巩膜轻～中度黄染6例,肝肿大(右肋下2.0～3.5cm)6例,大便色泽正常,肝区叩击痛阴性,脾未触及。右上腹饱满和压痛1例。实验室检查:肝功能血清丙氨酸转按酶66.7～150.2U/L,总胆红素58.7～171.2μmol/L,以结合胆红素增高为主,碱性磷酸酶178.4～300U/L。肝炎分型:抗—HAV IgM(-),HBV M(-),抗—HCV(-),抗—HEV(-)。患儿入院后经肝胆B超检
Pediatric Hospital of Shanghai Medical University Department of Infectious Diseases from October 1991 to February 1997 were treated in children with viral hepatitis 745 cases, of which 6 were admitted to hospital diagnosed as congenital biliary malformations, the highest misdiagnosis rate of the same period, this article The causes of misdiagnosis are as follows. 1 Clinical data 6 males and 4 females, 2 females; aged 46 days to 5 4/12 years old. Course of 12 to 30 days; admission to correct the diagnosis time of 2 to 5 days. Congenital biliary deformities and viral hepatitis have similar clinical manifestations: gastrointestinal symptoms in 6 cases (anorexia, nausea, vomiting), urine darker and thick tea water samples; abdominal pain in 2 cases; skin scleral light ~ moderate Yellow dye in 6 cases, hepatomegaly (right rib 2.0 ~ 3.5cm) in 6 cases, normal stool color, liver percussion pain, spleen not touched. Right upper quadrant full and tenderness in 1 case. Laboratory tests: Liver function serum alanine enzyme by enzyme 66.7 ~ 150.2U / L, total bilirubin 58.7 ~ 171.2μmol / L, with increased bilirubin, alkaline phosphatase 178.4 ~ 300U / L. Hepatitis types: anti-HAV IgM (-), HBV M (-), anti-HCV (-), anti-HEV (-). Children admitted to the liver and gallbladder B ultrasound