儿童胆道穿孔的超声诊断分析

目的探讨超声检查在儿童胆道穿孔诊断中的价值及诊断要点。 方法回顾性分析重庆医科大学附属儿童医院1996年9月至2019年6月经手术确诊为胆道穿孔的41例患儿临床资料和超声声像图表现。采用四格表分析超声检查提示胆道扩张和胆囊壁增厚对胆道穿孔的诊断效果。 结果胆道穿孔患儿主要临床表现：呕吐31例、腹痛23例、腹胀21例、发热18例、黄疸8例及腹膜刺激征阳性25例。41例胆道穿孔患儿的腹部超声检查结果：（1）有38例合并胆道异常，其中31例合并胆道扩张，20例合并胆囊壁增厚，2例合并胆囊结石；（2）4例空腹胆囊充盈困难；（3）36例合并腹水。超声检查提示胆道扩张诊断胆道穿孔的敏感度为90.63%，特异度为77.78%。超声提示胆囊壁增厚诊断胆道穿孔的敏感度为78.26%，特异度为88.89%。 结论对于因腹胀、呕吐、发热、黄疸等症状的就诊的患儿，超声检查发现胆道异常（胆道扩张、胆道壁增厚、胆道结石等）及不明原因的腹水，可嘱患儿空腹后复查，若患儿胆囊充盈困难，即可提示胆道穿孔，超声检查可以作为辅助诊断儿童胆道穿孔的可靠工具。

Ultrasound diagnosis of biliary tract perforation in children

Objective To explore the value and key points of ultrasound examination in the diagnosis of biliary tract perforation in children.Methods A retrospective analysis was performed on the clinical data and ultrasound sonograms of 41 children diagnosed with biliary tract perforation at Children's Hospital of Chongqing Medical University from September 1996 to June 2019.Results Main clinical manifestations included vomiting(n=31),abdominal pain(n=23),abdominal distension(n=21),fever(n=18),jaundice(n=8),and positive peritoneal irritation(n=25).Abdominal ultrasound examination of the 41 children with biliary tract perforation revealed 38 cases with bile duct abnormalities(including 31 cases with biliary dilatation,20 cases with gallbladder wall thickening,and 2 cases with gallbladder stones),4 cases with diminished gallbladder filling during fasting state,and 36 cases with ascites.Ultrasound showed that the sensitivity and specificity of biliary dilation for diagnosing biliary tract perforation were 90.63%and 77.78%,respectively,and those of gallbladder wall thickening were 78.26%and 88.89%,respectively.Conclusion For children with symptoms such as bloating,vomiting,fever,and jaundice,abnormal biliary tract(dilated biliary tract,thickened biliary wall,biliary stones,etc.)revealed by ultrasound,and unexplained ascites,further examination during fasting state is required.If diminished gallbladder filling is found,biliary tract perforation is suggested.Ultrasound examination can be used as a reliable tool to assist in the diagnosis of biliary tract perforation in children.