Myers Robert P, Fong Andrew, Shaheen Abdel Aziz M
Department of Medicine, Division of Gastroenterology, Liver Unit, University of Calgary, Calgary, AB, Canada.
Liver Int. 2008 May;28(5):705-12. doi: 10.1111/j.1478-3231.2008.01691.x.
Liver biopsy is an important tool in the management of patients with liver disease. Because biopsy practices may be changing, we studied patterns of use in a large Canadian Health Region. We aimed to describe trends in biopsy utilization and the incidence and costs of complications from a population-based perspective.
Administrative databases were used to identify percutaneous liver biopsies performed between 1994 and 2002. Significant complications were identified by reviewing medical records of patients hospitalized within 7 days of a biopsy and those with a diagnostic code indicative of a procedural complication. Analyses of biopsy rates employed Poisson regression.
Between 1994 and 2002, 3627 patients had 4275 liver biopsies (median 1 per patient; range 1-12). Radiologists performed the majority (90%), particularly during the latter years (1994 vs. 2002: 73 vs. 98%; P<0.0001). The overall annual biopsy rate was 54.8 per 100 000 population with a 41% (95% CI 23-61%) increase between 1994 and 2002. Annual increases were greatest in males and patients 30-59 years. Thirty-two patients (0.75%) had significant biopsy-related complications (1994-1997 vs. 1998-2002: 1.28 vs. 0.44%; P=0.003). Pain requiring admission (0.51%) and bleeding (0.35%) were most common. Six patients (0.14%) died; all had malignancies. The median direct cost of a hospitalization for complications was $4579 (range $1164-29 641).
Liver biopsy rates are increasing likely owing to the changing epidemiology and management of common liver diseases. The similarity of the complication rate in our population-based study with estimates from specialized centres supports the safety of this important procedure.
肝活检是肝病患者治疗中的一项重要手段。由于活检操作可能在发生变化，我们对加拿大一个大型健康区域的使用模式进行了研究。我们旨在从人群角度描述活检利用的趋势以及并发症的发生率和成本。
利用行政数据库识别1994年至2002年间进行的经皮肝活检。通过查阅活检后7天内住院患者的病历以及那些具有表明手术并发症诊断代码的患者病历，来确定严重并发症。活检率分析采用泊松回归。
1994年至2002年间，3627例患者接受了4275次肝活检（每位患者中位数为1次；范围为1至12次）。放射科医生进行了大部分活检（90%），尤其是在后期（1994年与2002年：73%对98%；P<0.0001）。总体年活检率为每10万人54.8次，1994年至2002年间增加了41%（95%可信区间23 - 61%）。男性和30至59岁患者的年增长率最高。32例患者（0.75%）出现了与活检相关的严重并发症（1994 - 1997年与1998 - 2002年：1.28%对0.44%；P = 0.003）。需要住院治疗的疼痛（0.51%）和出血（0.35%）最为常见。6例患者（0.14%）死亡；均患有恶性肿瘤。并发症住院的直接成本中位数为4579美元（范围为1164至29641美元）。
肝活检率可能因常见肝病的流行病学变化和管理方式改变而上升。我们基于人群的研究中并发症发生率与专业中心的估计相似，这支持了这一重要手术的安全性。
