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目的:探讨彩色多普勒超声对新生儿肝炎综合征(HS)和胆道闭锁(BA)的临床鉴别诊断价值。方法:收集2014年3月-2017年3月我院收治的53例HS患儿(淤胆型HS 32例,黄疸型HS 21例)和39例BA患儿,并于同期随机选取50例非黄疸性疾病婴儿作为对照组。所有研究对象均行彩色多普勒超声检查,分别比较不同患儿的超声检查结果,包括肝脾的大小、形态、内部回声、左右肝管及肝外胆管的可探性以及血流动力学变化等指标。结果:淤胆型HS组、黄疸型HS组患儿的空腹胆囊形态正常率高于BA组,但三组患儿均低于对照组(均P<0.05);淤胆型HS组、黄疸型HS组患儿胆囊收缩率>50%时间小于BA组,且三组均大于对照组(均P<0.05);淤胆型HS组、黄疸型HS组及对照组左右肝管及肝外胆管的显示率高于BA组(P<0.01);淤胆型HS组、黄疸型HS组及对照组患儿肝门部囊性回声率及纤维斑块率均低于BA组患儿(P<0.05)。BA组患儿的门静脉的平均流速(VPV)均低于其他三组,而PV淤血指数(CIPV)、肝动脉的前后径(DHA)、HA的阻力指数(RIHA)、HA/PV流速的比率(A/P)、脾动脉的RI(RISPA)水平均高于其他三组(均P<0.05)。结论:彩色多普勒超声可通过检查患者组织病理改变及血流动力学指标(VPV、CIPV、DHA、RIHA、A/P、RISPA)鉴别诊断HS和BA。
Objective: To investigate the clinical value of color Doppler ultrasound in the diagnosis of neonatal hepatitis syndrome (HS) and biliary atresia (BA). Methods: 53 cases of HS children (32 cases of cholestatic HS, 21 cases of jaundice HS) and 39 cases of BA were collected from March 2014 to March 2017 in our hospital. Fifty patients Jaundice disease infants as a control group. All subjects underwent color Doppler ultrasound examination, respectively, compared with different ultrasound findings in children, including the size of liver and spleen, morphology, internal echo, left and right hepatic and extrahepatic bile duct exploration and hemodynamic changes And other indicators. Results: The positive rate of fasting gallbladder in cholestatic HS group and jaundiced HS group was higher than that in BA group, but the children in all three groups were lower than those in control group (all P <0.05). The cholestatic HS group, jaundice The gallbladder contraction rate in HS group was> 50% less than BA group, and the three groups were larger than the control group (all P <0.05). In the cholestatic HS group, jaundiced HS group and the control group, the hepatic and extrahepatic bile ducts (P <0.01). The cystic echogenicity and fibrosis rate of hilar portal in cholestatic HS group, jaundice HS group and control group were lower than those in BA group (P <0.05) ). The mean velocity of portal vein (VPV) in BA group was lower than that of the other three groups. The ratio of PV congestion index (CIPV), hepatic artery anteroposterior diameter (DHA), RI of HA, HA / PV flow rate (A / P) and RI (RISPA) in splenic artery were higher than those in the other three groups (all P <0.05). Conclusion: Color Doppler ultrasound can differentiate HS and BA by examining the histopathological changes and hemodynamic parameters (VPV, CIPV, DHA, RIHA, A / P and RISPA).