经颈静脉肝活检与经皮肝活检和腹腔镜肝活检相比的临床相关性。
Clinical relevance of transjugular liver biopsy in comparison with percutaneous and laparoscopic liver biopsy.
作者信息
Beckmann Max G, Bahr Matthias J, Hadem Johannes, Bredt Martin, Wedemeyer Heiner, Schneider Andrea S, Kubicka Stefan, Manns Michael P, Strassburg Christian P, Wedemeyer Jochen
机构信息
Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl Neuberg Strasse 1, 30625 Hannover, Germany.
出版信息
Gastroenterol Res Pract. 2009;2009:947014. doi: 10.1155/2009/947014. Epub 2009 Nov 15.
BACKGROUND
Transjugular liver biopsy (TJLB) is frequently used to obtain liver specimens in high-risk patients. However, TJLB sample size possibly limits their clinical relevance.
METHODS
102 patients that underwent TJLB were included. Clinical parameters and outcome of TJLB were analyzed. Control samples consisted of 112 minilaparoscopic liver biopsies (mLLBs) and 100 percutaneous liver biopsies (PLBs).
RESULTS
Fewer portal tracts were detected in TJLB (4.3 +/- 0.3) in comparison with PLB (11.7 +/- 0.5) and mLLB (11.0 +/- 0.6). No difference regarding the specification of indeterminate liver disease and staging/grading of chronic hepatitis was observed. In acute liver failure (n = 32), a proportion of hepatocellular necrosis beyond 25% was associated with a higher rate of death or liver transplantation.
CONCLUSIONS
Despite smaller biopsy samples the impact on the clinical decision process was found to be comparable to PLB and mLLB. TJLB represents a helpful tool to determine hepatocellular necrosis rates in patients with acute liver failure.
背景
经颈静脉肝活检（TJLB）常用于高危患者获取肝脏标本。然而，TJLB的样本大小可能限制了其临床相关性。
方法
纳入102例行TJLB的患者。分析TJLB的临床参数和结果。对照样本包括112例微型腹腔镜肝活检（mLLB）和100例经皮肝活检（PLB）。
结果
与PLB（11.7±0.5）和mLLB（11.0±0.6）相比，TJLB检测到的门静脉分支较少（4.3±0.3）。在不确定肝病的诊断及慢性肝炎的分期/分级方面未观察到差异。在急性肝衰竭患者（n = 32）中，肝细胞坏死比例超过25%与更高的死亡率或肝移植率相关。
结论
尽管活检样本较小，但发现其对临床决策过程的影响与PLB和mLLB相当。TJLB是确定急性肝衰竭患者肝细胞坏死率的有用工具。
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