正常新生儿肝脏大小测定

正常儿童肝脏大小测量值在国外已屡见报道,所用方法为叩诊、触诊、搔抓试验、超声检查及X线摄片等;但适用于新产儿的测量方法及新生儿肝脏大小正常值报道者不     

新生儿和小婴儿肝脏婴儿型血管内皮瘤的诊断治疗探讨

目的　探讨新生儿和小婴儿的肝脏婴儿型血管内皮瘤的诊断治疗特点。方法　回顾分析 6例肝脏婴儿型血管内皮瘤并结合文献分析其临床表现、影像学检查、病理特点、治疗方法和疗效。结果　 6例中产前B超检查发现肝脏肿块 3例 ,因肝大腹部包块就诊 2例、黄疸 1例。无充血性心衰和Kasabach Merrit综合征等并发症发生。影像学检查 :B超均示肝脏低回声实性肿瘤影 ,血流丰富。CT平扫均示肝脏低密度肿块 ,可有散在或聚集颗粒状钙化 ;增强扫描边缘明显强化 ,逐渐向中心扩张。肿块大小不等。 6例均为单发病变 :肝右叶 4例、左叶 2例 ;肝内 2例、边缘 4例。血甲胎蛋白 (AFP)除 1例未查 ,5例均高于 12 10ng/mL。手术切除 5例 ,1例保守观察。病理特点 :6例均为Ⅰ型血管内皮瘤 :光镜下见由大小不等血管构成 ,管腔内壁可见肿胀增生的内皮细胞 ,核分裂相少见 ;免疫组化凝血Ⅷ因子 ( ) ,CD34( )。随诊 2个月至 2年 :手术患儿无复发 ,3例满 1岁者AFP降至正常 ;1例保守观察者随访至生后 7个月 ,肿瘤略缩小。 6例患儿均生长发育良好。结论　肝脏婴儿型血管内皮瘤发病早 ,多在胎儿晚期、新生儿期及 6个月内发现 ,为良性病变 ,须与肝母细胞瘤和神经母细胞瘤肝转移相鉴别 ;单发病灶无并发症者手术切除效果好 ,无症状者可以保守观     

川崎病肝脏损害的临床特征分析

目的分析川崎病肝脏损害的临床特征。方法对12，4例川崎病常规做肝功能检查，对41例肝功能异常者的临床资料进行分析。结果川崎病肝脏损害发生率为33％，肝功能异常主要表现为谷丙转氨酶(ALT)升高，或伴谷草转氨酶升高、血清白蛋白降低、白／球倒置；消化道表现轻；肝大轻度10例、中度5例；黄疸3例。对41例中有消化道表现伴肝大者给予一般保肝治疗，余均按川崎病治疗，肝功能、肝大、消化道表现均在1～3周恢复正常。结论川崎病肝脏损害发生率较高，但临床表现轻、黄疸少见、肝功能异常以轻度ALT升高为主，可有不同程度的肝大，多不经特殊处理，可随川崎病的好转而恢复。     

小儿感染庚型肝炎病毒后肝脏病毒核酸分布与临床关系的研究

目的 探讨小儿庚型肝炎病毒感染、肝脏庚型肝炎病毒核糖核酸（ＨＧＶ ＲＮＡ）分布与其他ＨＧＶ标志、肝脏病理损害及与临床的关系。方法 应用原位杂交（ＩＳＨ）检测１７例小儿乙型肝炎患儿肝脏ＨＧＶ ＲＮＡ。结果 １７例血清抗－ＨＧＶ阳性者,其中肝脏ＨＧＶ ＲＮＡ 阳性９例（９／１７,５３％）。肝脏ＨＧＶ ＲＮＡ 分布在汇周围,在肝小叶呈散在分布,多呈胞浆型;肝脏ＨＧＶ ＲＮＡ阳性组病变和阴性组比较以轻度（     

新生儿巨细胞病毒感染与胆道闭锁肝脏纤维化的相关研究

目的探讨新生儿巨细胞病毒感染与胆道闭锁肝脏损伤的关系。方法回顾我院2004年1月-2005年1月收治21例胆道闭锁患儿临床资料。对肝组织纤维化和肝细胞变性坏死程度分级，同时进行肝脏和肝门纤维块巨细胞病毒-pp65免疫荧光染色。根据血清及病毒学检查结果将病人分组，比较两组患儿肝功能，肝脏纤维化，肝细胞破坏程度。结果巨细胞病毒感染组13例，非感染组8例。两组肝功能各指标除总胆红素，γ-谷氨酰转肽酶外无明显差异。巨细胞病毒感染组肝脏纤维化程度重于非感染组（P〈0．05）。结论巨细胞病毒活动性感染加重胆道闭锁患儿胆汁淤积和肝脏的纤维化。     

轮状病毒肠炎合并肝脏损害108例的临床观察及护理

目的探讨轮状病毒肠炎合并肝脏损害的临床特征及护理方法。方法对485例轮状病毒肠炎患儿进行肝功能及肝脏B超检查，对其中108例合并肝脏损害者进行分析。结果肝脏损害患儿中，丙氨酸转移酶（ALT）升高者30例，占27．8％；天冬氨酸转移酶（AST）升高者18例，占16．7％；γ-谷氨酰转肽酶（γ-GT）升高者10例，占9．3％；ALT和AST2项酶同时升高者24例，占22．3％；ALT、AST和γ-GT3项同时升高者12例，占11．1％；转氨酶升高伴胆红素（TBIL或DBIL）升高者3例，占2．7％；肝功能异常伴肝肿大者8例，占7．4％。90％病例于2周内肝功能恢复正常。结论轮状病毒肠炎可同时合并肝脏损害，其中以ALT及AST升高为最多见，经过一般抗病毒及护肝治疗及细致的护理后，90％病例2周恢复正常。     

新生儿脐静脉置管术后肝脏损伤七例及文献复习

目的:研究新生儿脐静脉置管术后肝脏损伤的临床特点,为提高脐静脉置管的使用安全性提供科学参考依据。方法:回顾性收集2015年1月至2019年12月在广州医科大学附属第三医院新生儿科住院治疗并行脐静脉置管术的新生儿资料,总结和分析术后继发肝脏损伤病例的临床特点与诊治情况,并对相关文献报道进行复习。结果:共1 721例新生儿...     

婴儿肝炎综合征的临床病原学与肝脏的病理改变

本文对１５例婴儿肝炎综合征患儿进行血清病原学、肝脏活检组织病理光镜、电镜检查。发现ＣＭＶ感染９例，占６０％。表明本组婴肝的主要病因为ＣＭＶ感染。１４例病理光镜见多核巨细胞形成、灶性肝细胞坏死伴炎症细胞浸润，淤胆，汇管区纤维组织增生，弥漫性肝脂肪变性。尸检１例肝细胞内找到包涵体。１４例电镜主要改变为微器官锐减，线粒体、内质网及糖原减少。     

小儿局灶性结节性肝脏增生临床诊治经验探讨

目的探讨小儿局灶性结节性肝脏增生的临床特点、诊断方法及治疗经验,提高其诊治水平。方法回顾性分析2006年1月至2018年1月由首都医科大学附属北京儿童医院经手术切除及病理检查证实为局灶性结节性肝脏增生的患儿临床资料,其中男童9例,女童13例,发病年龄7个月至11岁1个月,中位年龄4岁6个月,所有病灶为单发,均经不规则性肝切除术治疗。结果临床表现:22例局灶性结节性肝脏增生(focal nodular hyperplasia,FNH)患儿中腹痛7例,腹部膨隆或包块4例,体检发现11例;实验室检验:肝功异常8例,AFP升高3例,均于术后恢复正常;影像学检查:所有22例均行超声检查,10例拟诊断为FNH,拟诊断正确率为45. 5%;误诊为肝脏血管瘤5例,其中肝母细胞瘤1例,间叶错构瘤1例。20例行CT(含增强)检查,11例拟诊断为FNH,拟诊断正确率为55%。3例术前行MRI检查,1例拟诊断为FNH,2例未予明确诊断。术后肿瘤最长径线5～15 cm,中位长度8 cm,其中≥10 cm者5例,最大肿物体积为15 cm×10 cm×8 cm。所有病例为单发病灶,均行手术切除,病理提示肿物中央灰白色放射样瘢痕特征11例(50%)。术后随访0. 5～10. 8年,未见复发或严重并发症发生。结论小儿局灶性结节性肝脏增生在临床及影像学上有一定特征,联合应用CT等影像学检查和AFP水平及肝功能实验室检查指标能提高其诊断水平,最终确诊需术后病理检查,手术切除治疗能够有效解除病灶,远期预后良好。     

Sonographic biometry of liver and spleen size in childhood

In 194 healthy children of all ages, sonographic measurements of the liver and spleen were performed on standardized section planes and normal values established. These measurement values showed an approximately linear increase in the course of development and correlated best with the body length. For a rapid orientative evaluation of the liver size, sonographic nomograms of the individual measurements were developed. The spleen size was determined by volume calculation. On the basis of an index of liver size, which was calculated from the individual measurements, a diagram for simultaneous determination of liver and spleen size could be developed. These nomograms permit objective morphometry of size changes in the two organs.     

Sonographic assessment of renal volume in Indian children

In an attempt to making norms of renal volume (RV) in Indian children, 240 children (137 boys and 103 girls) below 5 years of age were subjected to sonographic examination in supine position. Left RV in female children increased from 18.04 mm³ in early infancy to 48.36 mm³ in 4–5 year age group. Similar increase was observed in the right RV. There was no significant left vs. right difference in RV in boys and girls (p>0.05). Similarly, the RV did not differ significantly in both sexes (p>0.05, in all age groups except 4–5 years, p=0.04).     

Clinical and sonographic assessment of liver size in normal Chinese neonates

Liver size and midclavicular line were measured by clinical and sonographic methods in 145 normal Chinese neonates with gestational ages of 34–42 weeks. The liver span, measured by clinical methods with percussion and percussion/palpation methods, correlated well with that measured by sonography ( r = 0.73 and r = 0.76, respectively) for the entire sample. The liver spans (mean ± SD) obtained by sonography were 4.24 ± 0.63 cm and 4.58 ± 0.56 cm in the preterm and term neonates, respectively. The liver span (sonography) and the distance of the liver edge below the right costal margin were weakly related in the term neonates ( r = 0.36), but unrelated in the preterm neonates. We conclude that the liver span is a better estimate of liver size than the distance below the right coastal margin in normal neonates. We also found that the mean liver span is approximately 1 cm smaller in Chinese neonates than in Western neonates.     

Sonographic assessment of renal size and growth in premature infants

Background  

Low birth-weight infants are at risk for renal disease when renal insults occur in the neonatal period. Renal growth as measured by sonography over time is utilized by many nephrologists as predictors of future renal disease.     

Pre- and post-transplant assessment of liver function in paediatric liver transplantation

The pre-operative risk of paediatric liver transplantation candidates (n=41) was assessed in a prospective study by means of clinical symptoms, conventional static and liver blood flow dependent dynamic liver function tests. Nine patients died during the 365-day waiting period. The data were subjected as covariates to a survival analysis in the Cox proportional hazards model. There was a significant relationsship between the results of mono-ethylglycinexylidide (MEGX) formation and ICG test and the 365-day survival rate. In the stepwise analysis, none of the remaining parameters improved the predictive ability when added to the dynamic liver function test results. The assessment of post-transplantation liver function was studied in 27 patients during the first 28 postoperative-day period. In addition, liver function was studied in a cross-sectional study 1–7 years after successful liver transplantation in children with complete or partial rehabilitation. In the early postoperative period severe organ damage was indicated by both static and dynamic liver function tests. In the later course after transplantation no deterioration of liver function measured with MEGX formation was to be observed. These findings demonstrate the usefulness of dynamic liver function tests in the pre- and post-transplant assessment of liver function.     

Acute liver failure in neonates

Acute liver failure (ALF) in neonates is a rare but often fatal event. Though in adults and older children, a main symptom of ALF is hepatic encephalopathy, this is very difficult to diagnose and prove in infants. Causes of ALF in neonates encompass metabolic, infectious and haematological disorders, congenital vascular/heart abnormalities, and drugs. Infants with ALF should only be treated in specialised paediatric hepatology centres with facilities for liver transplantation, since for many liver transplant, with a long term survival of over 60%, is the only therapeutic option.     

新生儿含肝组织的巨型脐膨出的临床治疗抉择探讨

目的:回顾分析含有肝脏组织的巨型脐膨出(GO)的临床特征,探讨最佳治疗方式,改善预后,提高GO患儿救治率。方法:收集2009年1月至2019年5月在武汉儿童医院新生儿外科住院的GO患儿,治疗方法包括：1.使用类似Silo袋的方法,分期手术;2.一期直接或联合补片修补;3.保守治疗2～8周后延期一期手术。收集的数据包括患...     

Sonographic determination of renal volumes in normal neonates

Renal diseases that affect renal size without altering renal architecture require a quantitative means of detection. A prospective study was undertaken to establish normal values for renal volumes in healthy neonates using sonography. Volumes were determined by two methods; (1) the serial area-volume method using parallel transverse images; and (2) the prolate ellipsoid model of the kidney using orthogonal diameters taken from ultrasound images. Renal volumes for both the right and left kidneys in both sexes were found to be approximately 10 ml. There was no significant difference between the results obtained by either method, nor were there significant differences between the volumes of the right and left kidneys within either sex. No difference in renal volume was noted between sexes. The mean greatest renal length was also computed for right and left kidneys in both sexes. Knowledge of normal renal volumes may aid in the diagnosis of urinary system disorders in neonates.     

Sonographic biometry of liver and spleen size long after closure of abdominal wall defects

Little is known about the fate of the liver and spleen after closure of the abdominal cavity in patients with abdominal wall defects (AWD). Therefore, counselling families for long-term follow-up and in the case of surgery for acute disease, pregnancy or trauma may be difficult. A total of 18 patients ranging in age from 7 to 18 years, with AWD closed at birth, underwent ultrasound evaluation of liver and spleen size by determination of the index of liver size (ILS) and splenic volume (SV). These values were then correlated with some anthropometric parameters such as body mass index (BMI) and weight; correlation was also sought with some clinical features such as type of defect and direct or staged closure. Nearly all subjects exhibited weight above and BMI below the 50th percentile for age. ILS and SV were significantly above normal limits in all cases and no difference was found with regard to the type of defect. CONCLUSION: In patients having undergone surgery for abdominal wall defects, liver and spleen usually regain their normal shape and position even though size and volume appear to be larger than in normal controls.     

Sonographic findings in bacterial meningitis in neonates and young infants

Cranial sonography plays an important role in the initial evaluation of infants with suspected bacterial meningitis and in monitoring for complications of the disease. Echogenic widening of the brain sulci, meningeal thickening and hyperemia suggest the diagnosis in an at-risk population. Sonography can identify the presence of extra-axial fluid collections, and color Doppler sonography can be very helpful in differentiating benign enlargement of subarachnoid spaces from subdural effusions. Intraventricular debris and stranding, and an irregular and echogenic ependyma are highly suggestive findings associated with ventriculitis. Sonography can play an important role in the detection of postinfectious hydrocephalus, in the determination of the level of obstruction, and in the evaluation of intracranial compliance. Focal or diffuse parenchymal involvement can represent parenchymal involvement by cerebritis, infarction, secondary hemorrhage or early abscess.