Ridaura C
Instituto Nacional de Pediatrá, Insurgentes Sur 3700, 04530 México, DF.
Rev Invest Clin. 1990 Jul;42 Suppl:32-5.
Protracted cholestasis of infancy is a clinical and pathological manifestation of several injuries to the liver and biliary tract. Function liver biopsy is a well stablished procedure for cholestasis differential diagnosis which allows to guide therapeutics. In this review the author describe and analyse biopsy advantages and mention some of the technical and methodological considerations which permit to improve histological diagnosis. Preliminary results of a study of 110 punction liver biopsies from patients with neonatal protracted cholestasis are presented. In 42 patients a biliary atresia was found and a correlation with surgical findings was done. A 94% sensitivity, and 97% specificity for histological diagnosis was found. In contrast, gammagraphic diagnosis had a 100% sensitivity and only 77.7% specificity. In 16 patients, from a total of 38 with a final diagnosis of neonatal hepatitis, a biliary obstruction was initially suspected. In these 16 patients, a punction liver biopsy was not considered before the surgical exploration. However, a clear histological picture of neonatal hepatitis was found in the wedge liver biopsy obtained during abdominal laparotomy. This data confirms punction liver biopsy utility even if a highly suggestive clinical picture of biliary obstruction is found. It also allows to avoid unnecessary exploratory laparatomy.
婴儿期迁延性胆汁淤积是肝脏和胆道多种损伤的临床和病理表现。功能性肝活检是胆汁淤积鉴别诊断的一种成熟方法，可用于指导治疗。在本综述中，作者描述并分析了活检的优势，并提及了一些有助于改善组织学诊断的技术和方法学考量。文中呈现了一项对110例新生儿迁延性胆汁淤积患者进行经皮肝穿刺活检研究的初步结果。在42例患者中发现了胆道闭锁，并与手术结果进行了相关性分析。组织学诊断的敏感性为94%，特异性为97%。相比之下，放射性核素显像诊断的敏感性为100%，特异性仅为77.7%。在最终诊断为新生儿肝炎的38例患者中，有16例最初怀疑存在胆道梗阻。在这16例患者中，手术探查前未考虑进行经皮肝穿刺活检。然而，在剖腹手术中获取的楔形肝活检中发现了明确的新生儿肝炎组织学表现。这些数据证实了即使发现了高度提示胆道梗阻的临床表现，经皮肝穿刺活检仍具有实用性。它还可以避免不必要的剖腹探查术。
