临床小儿外科杂志2024，Vol.23Issue(12)：1125-1132,8.DOI:10.3760/cma.j.cn101785-202403047-004
囊肿型胆道闭锁的产前产后一体化鉴别诊断
Integrated pre-and post-natal differential diagnosis of cystic biliary atresia
摘要
Abstract
Objective Cystic Biliary Atresia(CBA)is a special type of Biliary Atresia(BA)that can be detected prenatally through ultrasound examination.It is easily confused with Choledochal Cyst(CC),and there is a certain challenge in differentiating between the two in early diagnosis.The purpose of this study is to explore the differences in prenatal ultrasonic imaging characteristics between CBA and CC cases,and to evaluate the value of conjugated bilirubin(CB)and total bile acid(TBA)levels in the early postnatal period(i.e.,within the first 2 weeks after birth)for the differential diagnosis of these two conditions.Methods This is a retrospective multicenter clinical study.The patients were divided into CBA group and CC group according to surgical outcome or final clinical outcome.The prenatal ultrasound image characteristics and the differences in CB and TBA values between the two groups were compared,and the diagnostic efficacy and cut-off value of these indicators in differentiating CBA and CC were evaluated by statistical analysis.Results A total of 143 children with hepatic portal cysts were included in this study,including 37 in the CBA group and 106 in the CC group.The mean time of initial diagnosis was(25.29±6.07)weeks of gestation.There was no difference in the initial volume and diameter of cysts between the two groups.However,the growth rate of cysts in the CC group was significantly higher than that in the CBA group.The average growth rate of cysts in the CC group was 8.34 times at the last prenatal ultrasound examination,while that in the CBA group was only 1.48 times.When the critical value of cyst volume growth was set to 3.90 times,the AUC and sensitivity for diagnosing CBA were 0.828(95％CI,0.728-0.929)and 83.3％,respectively.In addition,CB and TBA levels in the CBA group increased significantly from the first week after birth and continued to increase at the second week.When the critical value of CB1 was 24 μmol/L,and the critical value of TBA2 was 20.9 μmol/L,the Jorden index of CBA and CC reached the maximum value,which were 0.880 and 0.826,and the corresponding AUC were 0.902 and 0.860,respectively.Conclusions A series of prenatal ultrasonography indicated that newborns with a cyst volume increase of＜3.90 had a higher risk of CBA.In addition,abnormal gallbladder morphology is important for the prenatal diagnosis of CBA.CB and TBA within 2 weeks of birth can be used to distinguish CBA from CC.CB1 ≥24 μmol/L and TBA2≥20.9 μmol/L suggest a higher risk of CBA.关键词
囊肿型胆道闭锁/胆总管囊肿/诊断,鉴别/产前诊断/超声检查,产前/产后期,诊断/结合胆红素/总胆汁酸/婴儿,新生Key words
Cystic Biliary Atresia/Choledochal Cyst/Diagnosis,Differential/Prenatal Diagnosis/Ul-trasonography,Prenatal/Postpartum Period,Diagnosis/Conjugated Bilirubin/Total Bile Acid/Infant,Newborn引用本文复制引用
童明欣,任红霞,高志刚,冯杰雄,陈琦,虞梅,张志波,谢华,唐维兵,刘翔,杨合英,李英超,潘永康,詹江华,吕志宝..囊肿型胆道闭锁的产前产后一体化鉴别诊断[J].临床小儿外科杂志,2024,23(12):1125-1132,8.基金项目
国家自然科学基金(82170529) National Natural Science Foundation of China(82170529) （82170529）
