摘要
目的 分析胆道闭锁(BA)患儿的临床特点。方法 选取2016年9月至2019年8月广州市妇女儿童医疗中心收治并经外科手术胆道造影确诊的140例BA患儿为研究对象。对BA患儿的一般临床资料、实验室检查及影像学检查结果进行回顾性分析。结果 140例患儿大部分为足月儿,出生体质量正常。发病年龄为3.0(3.0,5.0)d,第1次就诊的时间为15.0(5.0,42.0)d,第1次行肝功能检验时间为(47.23±22.09)d,手术确诊时间为(73.86±20.99)d。51例排典型白陶土样便,130例患儿有肝脏肿大且质地变硬。γ-GT≥300 U/L的仅有79例,γ-GT<300 U/L的患儿治疗后复查GGT呈进行性上升,较治疗前比差异有统计学意义(P<0.05)。65例(46.43%)为BA患儿合并巨细胞病毒感染。肝胆超声诊断BA的阳性率为89.28%(125/140),MRCP的阳性率为70.73%(87/123)。结论 BA常见于足月适于胎龄儿,对于黄疸延迟消退或反复的患儿尽早行肝功能检查,诊疗过程中要重视肝脾查体,对于大便不典型、γ-GT<300 U/L患儿要动态观察,肝胆超声联合MRCP检查可提高诊断率。
Objective To investigate the clinical features of infants with biliary atresia(BA),improve the recognition of BA by pediatricians and the early diagnosis rate.Methods One hundred and forty children with BA confirmed by surgical cholangiography were chosen from Guangzhou Women and children's medical center in recent three years.The general clinical data,laboratory examination and imaging examination results of them were analyzed retrospectively.Results Most of the 140 cases were term infants with normal birth weight.The medium age of onset was 3.0(3.0,5.0)days,the medium initial visit time was 15.0(5.0,42.0)days.The first time of liver function examination was(47.23±22.09)days,and the time of operation diagnosis was(73.86±20.99)days.Only 36.43%of the patients discharged typical clay colored stool,92.86%of them had hepatomegaly and hardened texture.Only 50.71%of the patients with GGT≥300 U·L-1.After treatment,GGT of children with GGT<300 U·L-1 increased significantly(P<0.05).Sixty-five 46.43%of BA patients were complicated with cytomegalovirus infection.The positive rate of hepatobiliary-ultrasound and MRCP to diagnose BA were 89.28%(125/140)and 70.73%(87/123)respectively.Conclusion BA is common in term infants.The liver function for the children whose jaundice is delayed or repeated should be checked as early as possible.During the diagnosis and treatment process,attention should be paid to liver and spleen examination,and dynamic observation should be made for children with atypical stool and GGT<300 U·L-1.Hepatobiliary ultrasound combined with MRCP can improve the diagnosis rate.
作者
陈敏霞
李旭芳
徐翼
叶家卫
杨花梅
房春晓
王艳玲
谭丽梅
CHEN Min-xia;LI Xu-fang;XU Yi;YE Jia-wei;YANG Hua-mei;FANG Chun-xiao;WANG Yan-ling;TAN Li-mei(Department of Infections Disease,Guangzhou Women and Children′s Medical Center,Guangzhou 510120,China)
出处
《肝脏》
2020年第5期494-497,共4页
Chinese Hepatology
基金
国家重点基础研究发展计划(973计划2015CB554303)。
关键词
胆道闭锁
早期诊断
临床特征
Biliary atresia
Early diagnosis
Clinical feature
