病理分级指导超声对慢性乙型肝炎诊断的研究

目的通过慢性乙型肝炎(CHB)病理分级,探讨超声对CHB的诊断分级。方法对100例CHB患者行超声检查,并在超声引导下行肝穿刺活检和病理组织学检查,观察分析经病理学诊断为轻、中和重度CHB患者的超声表现情况。结果参照病理诊断结果,病理结果为轻度CHB者超声表现为声像图基本正常;病理诊断为中度CBD者超声表现为肝包膜欠光滑,实质呈点状强回声,略增粗,血管走行清晰,胆囊壁毛糙,胆囊壁增厚呈双影,脾脏一般厚度增大,长度正常,门静脉主干内径增宽或正常高值;病理诊断为重度CBD超声表现为肝包膜不光滑,实质呈点状强回声,增粗、增强,血管走行模糊,胆囊壁毛糙、增厚,脾脏增大,门静脉主干内径增宽。结论肝穿刺活检有一定的损伤性,操作不方便。通过慢性乙型肝炎病理分级指导超声诊断,以利于超声在诊断中度CHB、早期肝硬化及肝硬化中的临床作用。

Study of pathological classfication guided for diagnosis of chronic hepatitis B by ultrasound

Objective To explore the pathological classfication guided for diagnosis of chronic hepatitis B by ultrasound. Methods One hundred patients with CHB were examined by uhrasonography, the liver biopsy and pathological examination were performed under ultrasound guidance. The ultrasonic appearance of mild, moderate and severe CHB were observed and analyzed. Results The uhrasonic appearance of mild CHB was normal. The uhrasonic appearance of moderate CHB included ： smooth liver capsule ; strong and a little coarse parenchyma echo ; clear course of blood vessels ; coarse and ＂halo - like＂ thickened gall bladder wall; increase of spleen thickness; dilated or normal portal vein. The appearance of severe CHB included： unsmooth liver capsule; strong and coarse parenchyma echo; unclear course of blood vessels; coarse and thickened gall bladder wall; splenomegaly and dilated portal vein. Conclusion Liver biopsy is a invasive and inconvenient method. Ultrasound quantitative classification of CHB guided by pathological diagnosis has significant clinical value in diagnosis of moderate CHB, early cirrhosis and cirrhosis.