*Department of Surgery †Department of Radiology ‡Department of Gastroenterology §Department of Pathology, Children's Hospital Los Angeles ||Southern California Clinical and Translational Science Institute, University of Southern California and Children's Hospital Los Angeles, Los Angeles, CA.
J Pediatr Gastroenterol Nutr. 2013 Nov;57(5):644-8. doi: 10.1097/MPG.0b013e3182a0e0d8.
The aim of this study was to determine patient factors that predict diagnostic failure or increased risk of bleeding complications following percutaneous liver biopsy in children.
A retrospective review of all children undergoing percutaneous liver biopsy at a single institution between July 2008 and July 2011 was performed. Demographics, comorbid conditions, preprocedural diagnoses/indications, procedural details, laboratory data, pathologic diagnosis, and complications were recorded. Continuous data were analyzed by Wilcoxon test and categorical data by Fisher exact test to determine statistical significance.
Two hundred thirteen children (104 girls) with a median age of 7 years (range 1 week-22 years) underwent 328 percutaneous liver biopsies. Nine (4.2%) experienced a decrease in hemoglobin >2 g/dL, 7 required transfusion (3.3%), and 1 patient died (0.5%). Younger age (1.8 vs 84 months, P = 0.05) and lower preprocedural hematocrit (29.3 vs 34.3, P = 0.05) predicted bleeding complications, whereas the number of biopsies, comorbid conditions, and coagulopathy did not. Sixty-three (19.2%) biopsies were insufficient for definitive histologic evaluation on initial biopsy in 57 patients. Twenty-one of 57 patients (37%) underwent repeat percutaneous biopsy and 3 of 57 (8%) underwent surgical biopsy. Biopsy provided definitive diagnosis in 86% of cases when repeat biopsy was performed. Shorter specimen length (1.4 vs 1.7 cm, P < 0.01) and biopsies performed for unexplained elevation of liver function tests (34.9% vs 16.7%, P < 0.01) were predictive of nondiagnosis.
Percutaneous liver biopsy is safe with a low rate of bleeding-related complications. Ensuring adequate sample length and careful patient selection may further increase the diagnostic yield.
本研究旨在确定影响儿童经皮肝活检后诊断失败或增加出血并发症风险的患者因素。
对 2008 年 7 月至 2011 年 7 月在一家机构接受经皮肝活检的所有儿童进行回顾性分析。记录人口统计学资料、合并症、术前诊断/适应证、操作细节、实验室数据、病理诊断和并发症。连续数据采用 Wilcoxon 检验进行分析，分类数据采用 Fisher 确切检验进行分析，以确定统计学意义。
213 名儿童（104 名女孩）接受了 328 次经皮肝活检，中位年龄为 7 岁（范围为 1 周-22 岁）。9 名（4.2%）儿童血红蛋白下降>2 g/dL，7 名需要输血（3.3%），1 名患者死亡（0.5%）。年龄较小（1.8 岁与 84 个月，P = 0.05）和术前血细胞比容较低（29.3%与 34.3%，P = 0.05）预测出血并发症，而活检次数、合并症和凝血功能障碍并不预测出血并发症。57 名患者中有 63 次（19.2%）初始活检的标本量不足，无法进行明确的组织学评估。21 名患者（37%）接受了重复经皮活检，3 名患者（8%）接受了手术活检。当进行重复活检时，86%的病例都得到了明确的诊断。标本长度较短（1.4 厘米与 1.7 厘米，P < 0.01）和因不明原因的肝功能检查升高而行活检（34.9%与 16.7%，P < 0.01）是诊断不明确的预测因素。
经皮肝活检是安全的，出血相关并发症的发生率较低。确保足够的标本长度和仔细的患者选择可能会进一步提高诊断率。
