Friedman Lawrence S
Department of Medicine, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA 02462, USA.
Curr Gastroenterol Rep. 2004 Feb;6(1):30-6. doi: 10.1007/s11894-004-0023-4.
Liver biopsy continues to have a central role in the evaluation of patients with suspected liver disease. The procedure is often indicated to evaluate otherwise unexplained liver biochemical test abnormalities, but the precise degree of serum aminotransferase elevations that should prompt a liver biopsy is controversial, as is the need for liver biopsy in all patients with suspected nonalcoholic fatty liver disease and chronic hepatitis C. Standard liver biopsy is contraindicated in patients with severe coagulopathy and ascites, although the degree of coagulopathy that contraindicates a liver biopsy is controversial. A transjugular approach is an alternative in patients with coagulopathy or ascites. Controversy surrounds all the technical aspects of liver biopsy, particularly the choice of needle (cutting vs suction) and the use of ultrasound to mark or guide the biopsy site. Bleeding is the major complication of liver biopsy, with a risk of 0.3%; cutting needles are more likely to cause hemorrhage than are suction needles. Traditionally, liver biopsy has been the province of the hepatologist/ gastroenterologist. However, an increasing number of liver biopsies are performed by radiologists. The implications of this trend with respect to patient outcome, safety, and training of fellows is unclear.
肝活检在疑似肝病患者的评估中仍起着核心作用。该检查通常用于评估其他无法解释的肝脏生化检查异常情况，但究竟血清转氨酶升高到何种精确程度就应进行肝活检，这存在争议，对于所有疑似非酒精性脂肪性肝病和慢性丙型肝炎患者是否需要进行肝活检也存在争议。标准肝活检对于有严重凝血功能障碍和腹水的患者是禁忌的，尽管何种程度的凝血功能障碍会成为肝活检的禁忌存在争议。经颈静脉途径是凝血功能障碍或腹水患者的一种替代方法。肝活检的所有技术方面都存在争议，特别是穿刺针的选择（切割针与抽吸针）以及使用超声标记或引导活检部位。出血是肝活检的主要并发症，风险为0.3%；切割针比抽吸针更易导致出血。传统上，肝活检一直是肝病学家/胃肠病学家的工作领域。然而，越来越多的肝活检由放射科医生进行。这种趋势对患者预后、安全性以及住院医师培训的影响尚不清楚。
