Maharaj B, Bhoora I G
Department of Experimental and Clinical Pharmacology, University of Natal Medical School, Congella, South Africa.
Postgrad Med J. 1992 Dec;68(806):964-7. doi: 10.1136/pgmj.68.806.964.
The diagnostic yield of blind percutaneous liver biopsy is improved when two or three specimens are taken during the procedure by redirecting the needle through a single entry-site, without exposing the patient to a greater risk of complications provided that standard precautions are taken. This study was designed to obtain further data on the safety of this procedure at King Edward VIII Hospital, Durban. During the period 1984-1990 (inclusive) a total of 2,646 biopsies were carried out: a single specimen was obtained in 834 patients, two specimens in 983 patients and three in 829 patients. Complications directly attributable to the procedure occurred in 24 patients who had one specimen, 20 who had two, and 19 who had three specimens taken during the biopsy. A single specimen had been obtained from three of the eight patients who had died, two specimens had been taken from another patient, and three specimens were obtained from the other four patients, i.e. patients in whom two or three specimens were taken did not have a higher incidence of pain, symptomatic hypotension, biliary peritonitis or death than those in whom one specimen was taken. Accordingly, when blind percutaneous needle biopsy of the liver is carried out, two specimens should be obtained by redirecting the needle through a single entry site as this improves the diagnostic yield without increasing complications. The morbidity and mortality associated with liver biopsy in this hospital is, however, high. Good technique, careful monitoring of patients after biopsy and prompt and aggressive resuscitation are essential if the mortality rate is to be reduced.
在经皮肝穿刺活检过程中，如果采取标准预防措施，通过单个穿刺点重新引导穿刺针获取两到三个标本，可提高盲目经皮肝穿刺活检的诊断率，且不会使患者面临更高的并发症风险。本研究旨在获取关于德班爱德华八世医院该操作安全性的更多数据。在1984年至1990年（含）期间，共进行了2646例活检：834例患者获取了单个标本，983例患者获取了两个标本，829例患者获取了三个标本。活检过程中直接归因于该操作的并发症发生情况为：获取单个标本的24例患者出现并发症，获取两个标本的20例患者出现并发症，获取三个标本的19例患者出现并发症。在8例死亡患者中，3例获取了单个标本，另1例患者获取了两个标本，其余4例患者获取了三个标本，即获取两到三个标本的患者在疼痛、症状性低血压、胆汁性腹膜炎或死亡方面的发生率并不高于获取单个标本的患者。因此，在进行盲目经皮肝穿刺活检时，应通过单个穿刺点重新引导穿刺针获取两个标本，因为这可提高诊断率且不增加并发症。然而，该医院与肝活检相关的发病率和死亡率较高。如果要降低死亡率，良好的操作技术、活检后对患者的仔细监测以及迅速积极的复苏措施至关重要。
