超声监测重型肝炎患者肝内胆管回声变化的临床意义

目的 探讨超声监测重型肝炎患者门静脉右支前方肝内胆管超声表现的临床意义.方法 对57例接受住院治疗的重型肝炎患者进行超声监测,常规检查肝脏大小、门静脉血流动力学变化、胆囊及肝内胆管变化及腹腔积液等.观察治疗过程中57例重型肝炎患者肝内胆管回声变化和血总胆红素水平变化.结果 治疗过程中,57例重型肝炎患者中15例(15/57,26.3%)出现肝内胆管回声变化,42例(42/57,73.7%)肝内胆管回声无变化.肝内胆管回声变化组患者均表现为门静脉右支前方肝内胆管壁回声增厚、增强及管腔结构模糊不清,患者血总胆红素最高值的平均值为(457.8±141.1)μmol/L,明显高于肝内胆管回声无变化组患者的(299.9±116.1)μmol/L,且差异有统计学意义(t=3.89,P<0.05).肝内胆管回声变化组中12例病情好转患者肝内胆管回声变化逐渐消退,而3例死亡患者此声像改变持续存在.结论 治疗过程中超声监测重型肝炎患者门静脉右支前方肝内胆管回声变化对临床观察重型肝炎的治疗效果及判断预后有重要提示作用.

The clinical importance of monitoring intrahepatic bile duct by ultrasound in the severe hepatitis ultrasonic

Objective To investigate the ultrasonic manifestation and clinical value of intrahepatic bile duct anterior to right branch of portal vein ascites in the severe hepatitis. Methods The ultrasound was performed in 57 cases of severe hepatitis patients. The routine examinations included liver sizes,portal vein diameter and its hemodynamic changes,gallbladder and intrahepatic bile duct,spleen,etc. The total bilirubin （ TBIL） levels and the ultrasonic changes in intrahepatic bile duct during the treatment of the 57 severe hepatitis patients were analyzed. Results Among 57 severe hepatitis patients,15（ 15 /57,26. 3% ） presented thick and hyperechogenic intrahepatic bile duct wall during the treatment. And 42（ 42 /57,73. 7% ） had no changes of intrahepatic bile duct. The TBIL level in the group with the ultrasonic changes of intrahepatic bile duct was （ 457.8 ±141.1） μmol/L,and the TBIL level in the group without the ultrasonic changes of intrahepatic bile duct was（ 299. 9 ± 116. 1） μmol / L. The TBIL level in the group with the ultrasonic changes of intrahepatic bile duct was higher than that without intrahepatic bile duct changes. There was a significant difference between the two groups （ t = 3. 89,P 0. 05 ） . The ultrasonic findings of the intrahepatic bile duct gradually disappeared in 12 patients who recovered after treatment,while these findings still existed in 3 dead patients. Conclusion The ultrasonic changes of intrahepatic bile duct anterior to the right portal vein can indicate some important clinical information for treatment and prognosis in severe hepatitis.