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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2023, Vol. 20 ›› Issue (04) : 375 -383. doi: 10.3877/cma.j.issn.1672-6448.2023.04.001

所属专题： 总编推荐；

专家共识

婴儿胆道闭锁超声影像临床实践专家共识
中国医药教育协会超声医学专业委员会儿童超声学组, 中华医学会儿科学分会超声学组   
  • 收稿日期:2022-07-29 出版日期:2023-04-01

Expert consensus on clinical practice of ultrasound imaging in infants with biliary atresia

Pediatric Ultrasound Group of Ultrasound Medicine Professional Committee of China Medicine Education Association, Ultrasound Group of Pediatrics Society of Chinese Medical Association   

  • Received:2022-07-29 Published:2023-04-01
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中国医药教育协会超声医学专业委员会儿童超声学组, 中华医学会儿科学分会超声学组. 婴儿胆道闭锁超声影像临床实践专家共识[J]. 中华医学超声杂志（电子版）, 2023, 20(04): 375-383.

Pediatric Ultrasound Group of Ultrasound Medicine Professional Committee of China Medicine Education Association, Ultrasound Group of Pediatrics Society of Chinese Medical Association. Expert consensus on clinical practice of ultrasound imaging in infants with biliary atresia[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(04): 375-383.

表1 推荐等级方案
推荐强度 证据级别
A：强烈推荐 Ⅰ：一个或多个临床结果和（或）已验证的实验室观点
B：中等推荐 Ⅱ：一项或多项精心设计的非随机试验或队列研究
C：推荐可选 Ⅲ：专家建议
图1 胆道闭锁病理解剖分型示意图。图a示正常结构；图b示Ⅰ型胆总管闭锁及其囊肿型；图c示Ⅱ型肝管闭锁及其囊肿型；图d示Ⅲ型肝门部闭锁（常有明显肝门纤维板块）及其囊肿型（图中绿色示正常胆道，黑色示闭锁胆道）注：GB为胆囊；CBD为胆总管；HD为肝管；CYST为囊肿
图2 经肋间斜切面扫查胆囊声像变化示意图。图a~d为空腹或深度饥饿状态，其中图a~c为胆囊发育不全声像图，图d为正常胆囊声像图，声像图右下方为相对应的示意图；图e~h为餐后或饮奶后30~60 min，其中图e~g为胆囊发育不全声像图，图h为正常胆囊声像图，声像图右下方为相对应的示意图（图2a、2e左边的上下2张图片为经肋间斜切面扫查示意图，图中黑色示闭锁胆道，蓝色示门静脉）
图3 胆道闭锁患儿肝门部高回声索带声像示意图。图a~c为超声声像图，其中图a示肝右叶胆管纤维索带；图b示肝门部胆管纤维索带；图c示肝左叶胆管纤维索带；图a~c右下方示意图为胆管纤维索带与门静脉的关系，其中图a右下方为肝右叶胆管纤维索带示意图；图b右下方为肝门部胆管纤维索带示意图；图c右下方为肝左叶胆管纤维索带示意图（图a~c左下方分别为声像图对应的超声扫查切面示意图，图中黑色示闭锁胆道，蓝色示门静脉）
图4 胆道闭锁囊肿型超声声像图。图a为经右肋间斜切面声像图；图b为经肋缘下斜切面声像图。图a，b右下方为声像图对应的超声扫查切面示意图（图中黑色示闭锁胆道，蓝色示门静脉）注：CY为囊肿；图中三角形所示为胆囊
图5 肝包膜下彩色多普勒血流声像图。图a为正常肝包膜下血流；图b为胆道闭锁肝包膜下血流阳性。图a，b右下方为声像图对应的超声扫查切面示意图（图中绿色示正常胆道，黑色示闭锁胆道，蓝色示门静脉）
表3 胆道闭锁患儿超声扫查基本内容
图像名称 扫查内容 目的
经腹主动脉肝左叶纵切图 肝左外叶，尾状叶，门静脉左支横断面 观察肝脏回声，肝内胆道是否扩张，脐静脉开放
经下腔静脉肝左叶纵切图 肝左内叶，尾状叶 观察肝脏回声，肝内胆道是否扩张
经第一肝门的上腹部斜切图 肝左内叶、左外叶、尾状叶，门静脉主干及其左右分支，胆总管，肝门淋巴结 观察门静脉前方是否有纤维斑块，肝包膜下血流，肝门部是否有囊肿
经第二肝门的上腹部斜切图 肝左内叶、左外叶、右前叶、右后叶，肝静脉左、中、右三支 观察肝脏回声
经门脉右支右肋间斜切图 肝右后叶，门静脉主干、右支 评估肝动脉、门静脉的内径
胆囊长轴图 胆囊、胆管 观察胆囊的有无、大小和形态，囊壁的厚度
经脾脏长轴左肋间斜切图 脾脏、脾门血流 观察脾脏大小及形态，脾门血流
图6 正常肝脏常规扫查各切面声像图。图a为经下腔静脉肝左叶纵切图；图b为经腹主动脉左叶纵切图；图c为经第一肝门上腹部斜切图；图d为经第二肝门上腹部斜切图；图e为胆囊长轴图；图f为经门脉右支右肋间斜切图（中间为示意图，图中蓝色示门静脉，绿色示正常胆道）
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