对于凝血不好病人做肝穿/活检的评估...

liver411

Am. Coll. of Gastroenterology
Volume 98 , Issue 4 , Pages 893-900

[B]Liver assessment and biopsy in patients with marked coagulopathy: value of mini-laparoscopy and control of bleeding *[/B]

Ulrike Denzer M.D. a * , Ilka Helmreich-Becker M.D. a , Peter R. Galle M.D.
a and Ansgar W. Lohse M.D. a
Received: 2/17/2002. Accepted: 8/21/2002.


Abstract

Objectives

Evaluation of liver disease in patients with a high risk of postbiopsy
bleeding presents a diagnostic challenge. Mini-laparoscopy offers the
possibility of coagulation of biopsy site and the additional advantage of
macroscopic liver assessment. We wished to assess the value and safety of
mini-laparoscopy with guided biopsy as a diagnostic approach in patients in
whom percutaneous liver biopsy is considered contraindicated because of a
marked coagulopathy.


Methods


We investigated 61 consecutive patients with marked coagulopathy (prolonged
international normalized ratio > 1.5, thrombocytopenia < 50/nl, or both; von
Willebrand's disease/hemophilia). Diagnostic mini-laparoscopy with visually
guided liver biopsy was undertaken for the evaluation of liver disease.
Biopsy sites were coagulated prophylactically (n = 4) or therapeutically (n
= 52). Safety, diagnostic yield, and therapeutic consequences were assessed.


Results


Macroscopic assessment of the liver was possible in 60/61 high-risk patients
and was considered diagnostic in 1/61. In 58 of the remaining 60 patients,
liver biopsy was technically feasible. There was no persistent postbiopsy
bleeding. One patient with fulminant hepatic failure had self-limiting
bleeding from the abdominal wall. Ninety-seven percent of the biopsies were
of adequate size for diagnostic histological evaluation.


Conclusions


Mini-laparoscopy with guided liver biopsy allows reliable and safe
evaluation of liver disease in patients with severe coagulopathy.
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Dr. Helmreich-Becker's present address is: Gastroentological Practice,
Dotzheimerstr. 14, D-65185 Wiesbaden, Germany.Affiliations:
a First Department of Medicine, Johannes Gutenberg-University, Mainz,
Germany.
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