McAfee J H, Keeffe E B, Lee R G, Rösch J
Department of Medicine, Oregon Health Sciences University, Portland 97201-3098.
Hepatology. 1992 Apr;15(4):726-32. doi: 10.1002/hep.1840150429.
Although transjugular liver biopsy requires the availability of trained personnel, takes more time than percutaneous biopsy and is moderately expensive, it is a safe alternative technique for obtaining adequate liver tissue for diagnosis in special clinical situations. The usual indications for transjugular rather than percutaneous liver biopsy are (a) coagulation disorder (prothrombin time greater than 3 sec over control value and/or platelet count less than 60,000/cm3), (b) massive ascites and (c) desire to perform ancillary procedures, such as measurement of pressures or opacification of the hepatic veins and inferior vena cava. Less common indications for transjugular liver biopsy include failed percutaneous biopsy, massive obesity, small cirrhotic liver (increased risk and lower success rate) and suspected vascular tumor or peliosis hepatis. Results from several centers indicate that adequate or diagnostic liver tissue is obtained in 81% to 97% of cases. The typical length of the biopsy core ranges from 0.3 cm to 2.0 cm. Modification of the classic technique, particularly the adaptation of a Tru-Cut needle, shows promise in yielding longer cores of tissue with less fragmentation. Transjugular liver biopsy is performed with an acceptable complication rate that ranges 0% to 20%. The reported mortality of transjugular liver biopsy was 0 in three major centers and ranged from 0.1% to 0.5% in three other centers. Transjugular liver biopsy may be useful in obtaining diagnostic liver tissue not only in advanced chronic liver disease with coagulopathy, ascites or both, but also in patients with fulminant hepatic failure to better determine prognosis and the need for liver transplantation.
尽管经颈静脉肝活检需要有经过培训的人员，比经皮肝活检耗时更长且费用适中，但在特殊临床情况下，它是获取足够肝脏组织用于诊断的一种安全替代技术。通常采用经颈静脉而非经皮肝活检的指征包括：（a）凝血功能障碍（凝血酶原时间比对照值延长超过3秒和/或血小板计数低于60,000/立方厘米），（b）大量腹水，以及（c）希望进行辅助操作，如测量压力或使肝静脉和下腔静脉显影。经颈静脉肝活检较少见的指征包括经皮肝活检失败、极度肥胖、小的肝硬化肝脏（风险增加且成功率较低）以及怀疑血管肿瘤或肝紫癜。多个中心的结果表明，81%至97%的病例能获取足够或具有诊断价值的肝脏组织。活检组织芯的典型长度为0.3厘米至2.0厘米。对经典技术的改进，特别是采用Tru-Cut针，有望获取更长且破碎较少的组织芯。经颈静脉肝活检的并发症发生率在0%至20%之间，是可以接受的。三个主要中心报告的经颈静脉肝活检死亡率为0，另外三个中心的死亡率在0.1%至0.5%之间。经颈静脉肝活检不仅在患有凝血功能障碍、腹水或两者兼有的晚期慢性肝病患者中，而且在暴发性肝衰竭患者中，对于更好地确定预后和肝移植需求可能都有用。
