术中肝包膜下蜘蛛样毛细血管扩张征对胆道闭锁的明确诊断。

Intraoperative hepatic subcapsular spider-like telangiectasia sign for the definitive diagnosis of biliary atresia.

机构信息

Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.

Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, 563000, China.

出版信息

BMC Pediatr. 2023 Feb 6;23(1):63. doi: 10.1186/s12887-022-03831-z.

DOI:10.1186/s12887-022-03831-z

PMID:36747150

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9900992/

Abstract

OBJECTIVE

To evaluate the accuracy of intraoperative hepatic subcapsular spider-like telangiectasia (HSST) sign for differentiating biliary atresia (BA) from other causes of hepatic cholestasis.

METHODS

The data of 69 patients with jaundice treated from January 2019 to December 2021 were retrospectively analyzed. Based on intraoperative cholangiography (IOC), the patients were divided into two groups: the BA group (n = 49) and the non-BA group (n = 20). The biochemistry tests, liver ultrasound, liver stiffness value and HSST sign of the two groups were compared.

RESULTS

The incidence of abnormal gallbladder, elevated γ-glutamyl transpeptidase (γ-GGT) > 182.0U/L and abnormal liver stiffness (> 6.4 kPa) in BA group were significantly higher than those in non-BA group (P < 0.001). The HSST sign was present in all BA patients and not found in non-BA group. The area under receiver operating curve of direct bilirubin(DBIL), γ-GGT, abnormal gallbladder, liver stiffness value and HSST sign were 0.53, 0.84, 0.78, 0.96, and 1.00, respectively. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value(NPV) of HSST sign in the diagnosis of BA were all 100%.

CONCLUSION

Presence of HSST sign on diagnostic laparoscopy is highly suggestive of BA.It can be used in the differential diagnosis of BA and non-BA.

LEVEL OF EVIDENCE

Level III.

摘要

目的

评估术中肝包膜下蜘蛛样毛细血管扩张（HSST）征鉴别胆道闭锁（BA）与其他肝内胆汁淤积原因的准确性。

方法

回顾性分析 2019 年 1 月至 2021 年 12 月期间收治的 69 例黄疸患者的资料。根据术中胆管造影（IOC）结果，将患者分为 BA 组（n = 49）和非 BA 组（n = 20）。比较两组患者的生化检查、肝脏超声、肝脏硬度值和 HSST 征。

结果

BA 组异常胆囊、γ-谷氨酰转肽酶（γ-GGT）升高（> 182.0U/L）和肝脏硬度值异常（> 6.4kPa）的发生率显著高于非 BA 组（P < 0.001）。所有 BA 患者均出现 HSST 征，而非 BA 组未发现该征。直接胆红素（DBIL）、γ-GGT、异常胆囊、肝脏硬度值和 HSST 征的受试者工作特征曲线下面积分别为 0.53、0.84、0.78、0.96 和 1.00。HSST 征诊断 BA 的灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）均为 100%。