Oshrine Benjamin, Lehmann Leslie E, Duncan Christine N
Children's Hospital Boston †Dana-Farber Cancer Institute, Boston, MA, USA.
J Pediatr Hematol Oncol. 2011 Apr;33(3):e92-7. doi: 10.1097/MPH.0b013e3182025236.
Liver dysfunction is common after pediatric hematopoietic stem cell transplantation (HSCT) and liver biopsy may be necessary to diagnosis the cause of liver dysfunction and institute therapy. We report our liver biopsy experience in 356 consecutive patients. During the study period, 16 (4.5%) patients underwent 18 biopsies, all after allogeneic HSCT. The median time from HSCT to biopsy was 205.5 days. All patients had transaminase elevation and 67% had hyperbilirubinemia. The most commonly used method of biopsy was the imaging-guided percutaneous approach, performed in 12 of 18 cases. Five biopsies were done transjugularly and 1 was performed during laparotomy. In all the cases a histopathologic diagnosis was made. The most common diagnosis was graft-versus-host disease (GVHD) followed by iron overload. In 12 cases, management was modified based on biopsy results. Complications occurred after 5 biopsies, 4 of which were performed transjugularly. The most common complication was hemorrhage. Two patients required transfer to the intensive care unit for related complications. No complications were observed after percutaneous biopsies. In 2 cases a second procedure was required to manage the complication. We conclude that while liver biopsy yields a high-rate of diagnoses, it is accompanied by high rates of complications, particularly when the transjugular approach is used.
肝功能障碍在儿童造血干细胞移植（HSCT）后很常见，可能需要进行肝活检以诊断肝功能障碍的原因并制定治疗方案。我们报告了连续356例患者的肝活检经验。在研究期间，16例（4.5%）患者接受了18次活检，均在异基因HSCT后进行。从HSCT到活检的中位时间为205.5天。所有患者均有转氨酶升高，67%有高胆红素血症。最常用的活检方法是影像引导下经皮穿刺，18例中有12例采用此方法。5次活检通过经颈静脉进行，1次在剖腹手术期间进行。所有病例均做出了组织病理学诊断。最常见的诊断是移植物抗宿主病（GVHD），其次是铁过载。12例患者根据活检结果调整了治疗方案。5次活检后出现并发症，其中4次是经颈静脉进行的。最常见的并发症是出血。2例患者因相关并发症需要转入重症监护病房。经皮活检后未观察到并发症。2例患者需要进行第二次手术来处理并发症。我们得出结论，虽然肝活检诊断率高，但并发症发生率也高，尤其是使用经颈静脉途径时。
