Amatya Puja, Shah Dheeraj, Gupta Natasha, Bhatta Nisha K
Department of Pediatrics and Adolescent Medicine, B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal,
Indian J Pediatr. 2014 May;81(5):441-5. doi: 10.1007/s12098-013-1288-0. Epub 2013 Nov 28.
To measure the normal range of dimensions of liver in children of various age groups and to compare the liver measurement obtained by palpation-percussion, auscultation and ultrasonography.
This was a cross-sectional comparative study in which 500 normal (weight for height between ± 2 SD of WHO standards for children aged less than 5 y and BMI between ± 2 SD of WHO standards for children aged more than 5 y) children (0-15 y) divided in 5 age groups (100 in each age group). Subjects were enroled from normal hospital delivery neonates, children visiting immunization and well baby clinics, children visiting outpatient and inpatient department with minor illnesses and healthy school children.
The normal range of dimensions of liver in children were estimated and percentile tables of liver size were established. Though the measurements obtained by clinical methods were significantly (P < 0.001) lower than those obtained by ultrasonography, there was a strong correlation between clinical and ultrasonographic measurement. Palpation-percussion method could estimate the liver size within ± 1.0 cm of what was obtained by ultrasonography in 88 % of cases. In more than half of the study children (54.2 %), this estimation was within ± 0.5 cm.
Clinical methods of liver span estimation strongly correlate with ultrasonographic measurement. The performance of palpation-percussion method is better than that of auscultation. Clinical methods should continue to be used for the estimation of liver size.
测量不同年龄组儿童肝脏大小的正常范围，并比较触诊 - 叩诊、听诊及超声检查所测得的肝脏大小。
这是一项横断面比较研究，500名正常儿童（0 - 15岁）被分为5个年龄组（每组100名）。纳入标准为：5岁以下儿童身高体重在WHO标准±2标准差范围内，5岁以上儿童BMI在WHO标准±2标准差范围内。研究对象来自正常医院分娩的新生儿、前往免疫接种及健康婴儿诊所的儿童、因轻症前往门诊及住院部的儿童以及健康在校儿童。
估算出儿童肝脏大小的正常范围，并建立了肝脏大小百分位数表。尽管临床方法所测得的结果显著低于超声检查结果（P < 0.001），但临床测量与超声测量之间存在很强的相关性。在88%的病例中，触诊 - 叩诊法估算的肝脏大小与超声检查结果的差值在±1.0 cm以内。在超过一半（54.2%）的研究儿童中，该估算差值在±0.5 cm以内。
临床估算肝脏大小的方法与超声测量密切相关。触诊 - 叩诊法的表现优于听诊法。临床方法应继续用于肝脏大小的估算。
