Scheimann A O, Barrios J M, Al-Tawil Y S, Gray K M, Gilger M A
Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland 21287, USA.
J Pediatr Gastroenterol Nutr. 2000 Nov;31(5):536-9. doi: 10.1097/00005176-200011000-00015.
Percutaneous liver biopsy is a valued tool of pediatric hepatology. Recent advances in technology have incorporated spring-loaded biopsy needles and ultrasonography in percutaneous liver biopsy.
To determine the frequency of complications after liver biopsy and whether variables such as needle selections (Jamshidi, Monopty, or ASAP) and ultrasound guidance could predict complications, medical records were retrospectively reviewed of all patients who underwent percutaneous liver biopsy during a 7-year period. Available data were collected from 123 patients who had undergone a total of 249 percutaneous liver biopsies. All patients with evidence of mild clotting abnormalities (8.83%) received platelets, cryoprecipitate, or fresh-frozen plasma.
There was a 6.83% incidence of overall complications, and a 2.4% incidence of major complications. The mortality rate was 0.4%. Ultrasound localization did not diminish the risk of bleeding during biopsy. There was no significant difference in the change of hematocrit between the aspiration (Jamshidi) and spring-loaded (Monopty) needles. However, in patients less than 5 years of age, the change of hematocrit was significantly higher (P < 0.05) with the 15- or 18-gauge ASAP needle (Microvasive, Quincy, MA, U.S.A.) than with either the Jamshidi (Allegience Healthcare, Columbia, MD, U.S.A.) or Monopty (Bard Technologies, Covington, GA, U.S.A.) needles.
Percutaneous liver biopsy is safe, using either aspiration or spring-loaded needles. Ultrasound guidance may not be helpful except in patients who underwent segmental liver transplantation.
经皮肝穿刺活检是小儿肝病学中一项重要的检查手段。技术的最新进展已将弹簧式活检针和超声检查纳入经皮肝穿刺活检。
为确定肝活检后并发症的发生率，以及诸如穿刺针选择（Jamshidi针、Monopty针或ASAP针）和超声引导等因素是否可预测并发症，我们回顾性分析了7年间所有接受经皮肝穿刺活检患者的病历。从123例患者中收集了可用数据，这些患者共接受了249次经皮肝穿刺活检。所有有轻度凝血异常证据的患者（8.83%）均接受了血小板、冷沉淀或新鲜冰冻血浆治疗。
总体并发症发生率为6.83%，严重并发症发生率为2.4%。死亡率为0.4%。超声定位并未降低活检期间出血的风险。抽吸式（Jamshidi）针和弹簧式（Monopty）针穿刺后血细胞比容的变化无显著差异。然而，在5岁以下的患者中，15号或18号ASAP针（美国马萨诸塞州昆西市Microvasive公司生产）穿刺后血细胞比容的变化显著高于Jamshidi针（美国马里兰州哥伦比亚市Allegience Healthcare公司生产）或Monopty针（美国佐治亚州卡温顿市Bard Technologies公司生产）（P < 0.05）。
使用抽吸式或弹簧式活检针进行经皮肝穿刺活检是安全的。超声引导可能并无帮助，除非是接受节段性肝移植的患者。
