超声引导下经皮肝穿刺活检的临床应用及其18年的安全性

StephenW

Clin Mol Hepatol

. 2020 May 25.
doi: 10.3350/cmh.2019.0019n. Online ahead of print.
Clinical Application of Ultrasonography-Guided Percutaneous Liver Biopsy and Its Safety Over 18 Years
Young Chang  1 , Jun Il Kim  2 , Bora Lee  3 , Sang Gyune Kim  2 , Min Jung Jung  4 , Young Seok Kim  2 , Soung Won Jeong  1 , Jae Young Jang  1 , Jeong-Ju Yoo  2
Affiliations
Affiliations

    1
    Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.
    2
    Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
    3
    Department of Biostatistics, Chung-Ang University Graduate School, Seoul, Korea.
    4
    Department of Pathology Soonchunhyang University College of Medicine, Bucheon, Korea.

    PMID: 32447878 DOI: 10.3350/cmh.2019.0019n

Abstract

Background/aims: Liver biopsy (LB) remains the gold standard for the evaluation of liver disease. However, over the past two decades, many noninvasive tests have been developed and utilized in clinical practice as alternatives to LB. The aim of this study was to evaluate the clinical use and safety of LB in the era of noninvasive assessment of liver fibrosis.

Methods: This retrospective study included 1,944 consecutive cases of LB performed between 2001 and 2018 in a tertiary hospital. All of the LBs were conducted under ultrasonography guidance with 18-gauge cutting needles.

Results: LBs were performed an average of approximately 108 times per year during the study period. Chronic hepatitis B (25.3%) and suspected malignancy (20.5%) were the two most common indications for LB. The use of LB for nonalcoholic fatty liver disease increased from 8.1% to 17.2% in the past 5 years compared to the last 10 years, while that for viral hepatitis decreased from 40.3% to 18.9%. Discordance rate between the suspected diagnosis and the final diagnosis was 2.6% (51 cases). The overall rate of major adverse events was 0.05% (one case), which involved delayed bleeding at the biopsy site. Liver cirrhosis was observed in 563 cases (28.9%), and the presence of cirrhosis did not affect the frequency of complications (P=0.289).

Conclusions: LB is widely used in clinical practice as an irreplaceable diagnostic tool, even in the era of noninvasiveness. Ultrasonography-guided LB can be performed safely in patients with liver cirrhosis.

Keywords: Complication; Indication; Liver biopsy.

StephenW

临床分子肝素

。 2020年5月25日。
doi：10.3350 / cmh.2019.0019n。在线印刷。
超声引导下经皮肝穿刺活检的临床应用及其18年的安全性
Young Chang 1，Jun Il Kim 2，Bora Lee 3，Sang Gyune Kim 2，Min Jung Jung 4，Young Seok Kim 2，Soung Won Jeong 1，Jae Young Jang 1，Jeong-Ju Yoo 2
隶属关系
隶属关系

    1个
    韩国首尔不久春阳大学医学院内科。
    2
    朝鲜春川大学医学院内科学系，韩国富川市。
    3
    中韩大学研究生院生物统计学系，韩国首尔。
    4
    朝鲜春川大学医学院病理学系，韩国富川市。

    PMID：32447878 DOI：10.3350 / cmh.2019.0019n

抽象

背景/目的：肝活检（LB）仍然是评估肝脏疾病的金标准。然而，在过去的二十年中，已经开发了许多非侵入性测试并将其作为LB的替代品用于临床。这项研究的目的是在无创性评估肝纤维化时代评估LB的临床使用和安全性。

方法：这项回顾性研究包括2001年至2018年在三级医院连续进行的1,944例LB病例。所有的LB均在超声引导下用18号切割针进行。

结果：在研究期间，LB平均每年执行约108次。慢性乙型肝炎（25.3％）和可疑恶性肿瘤（20.5％）是LB的两个最常见适应症。与过去10年相比，过去5年中LB在非酒精性脂肪肝疾病中的使用率从8.1％增加到17.2％，而病毒性肝炎的使用率从40.3％减少到18.9％。疑似诊断与最终诊断的不符率为2.6％（51例）。主要不良事件的总发生率为0.05％（1例），其中涉及活检部位的延迟出血。观察到肝硬化563例（28.9％），并且肝硬化的存在并不影响并发症发生的频率（P = 0.289）。

结论：即使在无创时代，LB在临床实践中仍被广泛用作不可替代的诊断工具。超声引导下的LB可在肝硬化患者中安全地进行。

关键词：并发症适应症；肝活检。

StephenW

https://www.e-cmh.org/upload/pdf/cmh-2019-0019n.pdf