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目的探讨胆道闭锁(BA)的临床特点与BA误诊原因,以提高其早期诊断率。方法对1995年12月-2010年2月四川大学华西医院收治的53例BA患儿的临床表现及实验室、影像学检查结果进行分析总结,比较其黄疸出现时间与初诊时年龄分布,并分析其彩超、肝胆显像与手术结果的符合率。采用SPSS13.0软件进行统计学分析。结果患儿均出现黄疸,出现肝大32例[60.3%(32/53例)]、TORCH检查结果异常9例[60.0%(9/15例)],伴畸形9例[16.9%(9/53例)。2周龄前出现黄疸31例(58.5%),2周龄后出现黄疸22例(41.5%)。起病时临床误诊为婴儿肝炎综合征16例(30.2%)。46例行腹部彩超检查,其中彩超误诊为先天性胆总管囊肿14例(30.4%)。腹部超声诊断准确率为56.5%(26例)。40例行剖腹探查,均证实为BA,准确率为100.0%。结论黄疸和肝大是BA的主要临床症状。腹部超声检查是诊断BA的重要依据,对于合并TORCH检查结果异常、伴畸形、超声提示胆囊异常病例,应高度警惕BA。
Objective To investigate the clinical characteristics of biliary atresia (BA) and the causes of misdiagnosis in order to improve its early diagnosis rate. Methods The clinical manifestations, laboratory findings and imaging findings of 53 BA patients admitted to West China Hospital of Sichuan University from December 1995 to February 2010 were analyzed. The time of onset of jaundice and the age distribution of first visit were compared and analyzed The color Doppler ultrasound, hepatobiliary imaging and surgical results in line with the rate. SPSS13.0 software was used for statistical analysis. Results There were 32 cases (60.3% (32/53 cases)) of liver disease, 9 cases (60.0% (9/15 cases)) with abnormal TORCH and 9 cases (16.9% 53 cases). There were 31 cases (58.5%) of jaundice before 2 weeks old and 22 cases (41.5%) of jaundice after 2 weeks old. Clinical onset misdiagnosed as infantile hepatitis syndrome in 16 cases (30.2%). Forty-six cases underwent abdominal ultrasonography, of which 14 cases (30.4%) were misdiagnosed as congenital choledochal cyst. Abdominal ultrasound diagnostic accuracy was 56.5% (26 cases). 40 cases of laparotomy, were confirmed as BA, the accuracy rate of 100.0%. Conclusion Jaundice and hepatomegaly are the main clinical symptoms of BA. Abdominal ultrasound is an important basis for the diagnosis of BA, combined with TORCH abnormal results, with deformity, ultrasound abnormal gallbladder cases should be highly vigilant BA.