Lee B C, McGahan J P, Perez R V, Boone J M
Department of Radiology, University of California Davis Medical Center, Sacramento, USA.
Clin Transplant. 2000 Oct;14(5):493-8. doi: 10.1034/j.1399-0012.2000.140508.x.
The purpose of this study was to investigate the effectiveness and safety of percutaneous pancreatic transplant biopsy guided by ultrasound alone or with a combination of computerized tomography (CT) for pancreas localization and ultrasound for needle placement. We also compare our finding on the use of 18-gauge and 20-gauge needles for percutaneous pancreatic transplant biopsy. In 42 attempted biopsies performed on 21 patients, two different imaging modalities were used. Twenty-seven attempted biopsies were performed under the guidance of ultrasound alone, and 15 used a combination of ultrasound and CT. Of the 27 ultrasound-guided biopsies. 24 produced at least one sample adequate for histopathological analysis for an 89% biopsy success rate. Of the 15 biopsies guided by combined ultrasound and CT, 11 produced adequate samples for a 73% success rate. For all biopsies, an 83% success rate was found. In assessing the use of 18-gauge versus 20-gauge needles, 86 out of 110 tissue cores were adequate for histopathological analysis for a 78% yield. In 27 biopsy attempts using the 18-gauge needle, 75 tissue cores were obtained, for an average of 2.8 cores per biopsy. Fifty-seven pancreas samples collected using the 18-gauge needle were adequate for pathological evaluation for a 76% yield. With 15 biopsy attempts using the 20-gauge needle, 35 tissue cores were collected, for an average of 2.3 cores per biopsy. Twenty-nine pancreas specimens obtained from using the 20-gauge needle were adequate for analysis for an 83% yield. No major complications occurred. Only one incidence of minor complication was reported for a 2% complication rate. The only complication was local, mild bleeding at the biopsy site in one case. Air within the transplant pancreas as revealed by post-biopsy scans and streaky density appearing adjacent to the biopsy site occurred in a total of four cases and were not included. No complications were reported that required any invasive intervention. We conclude that percutaneous biopsy guided by ultrasound is a safe, simple, and effective method to detect pancreatic transplant rejection. Our results for biopsies compare favorably with other reported techniques in terms of effectiveness, complication rates, and ease of use. With its high success rate and low complications, ultrasound-guided percutaneous biopsy is an excellent method to sample pancreatic transplant.
本研究的目的是调查单纯超声引导或联合计算机断层扫描（CT）进行胰腺定位及超声引导进针的经皮胰腺移植活检的有效性和安全性。我们还比较了使用18号和20号针进行经皮胰腺移植活检的结果。对21例患者进行了42次活检尝试，采用了两种不同的成像方式。27次活检尝试仅在超声引导下进行，15次活检采用超声和CT联合引导。在27次超声引导活检中，24次获取了至少一个适合组织病理学分析的样本，活检成功率为89%。在15次超声和CT联合引导活检中，11次获取了足够的样本，成功率为73%。所有活检的成功率为83%。在评估18号针与20号针的使用情况时，110个组织芯中有86个适合组织病理学分析，取材率为78%。在27次使用18号针的活检尝试中，获取了75个组织芯，平均每次活检2.8个芯。使用18号针采集的57个胰腺样本适合病理评估，取材率为76%。在15次使用20号针的活检尝试中，采集了35个组织芯，平均每次活检2.3个芯。使用20号针获得的29个胰腺标本适合分析，取材率为83%。未发生重大并发症。仅报告了1例轻微并发症，并发症发生率为2%。唯一的并发症是1例活检部位局部轻度出血。活检后扫描显示移植胰腺内有气体以及活检部位附近出现条纹状密度影的情况共4例，未纳入统计。未报告需要任何侵入性干预的并发症。我们得出结论，超声引导下经皮活检是检测胰腺移植排斥反应的一种安全、简单且有效的方法。我们的活检结果在有效性、并发症发生率和易用性方面与其他报道的技术相比具有优势。超声引导下经皮活检成功率高、并发症少，是采集胰腺移植样本的一种极佳方法。
