Boyum James H, Atwell Thomas D, Schmit Grant D, Poterucha John J, Schleck Cathy D, Harmsen W Scott, Kamath Patrick S
Department of Radiology, Mayo Clinic, Rochester, MN.
Department of Radiology, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2016 Mar;91(3):329-35. doi: 10.1016/j.mayocp.2015.11.015. Epub 2016 Feb 2.
To determine the incidence of major adverse events related to a large volume of image-guided liver biopsies performed at our institution over a 12-year period and to identify risk factors for major bleeding events.
A retrospective analysis of an internally maintained biopsy registry was performed. The analysis revealed that 6613 image-guided liver biopsies were performed in 5987 adult patients between December 7, 2001, and December 31, 2013. Liver biopsies were performed using real-time ultrasound guidance and a spring-loaded biopsy device, with rare exceptions. Adverse events considered major and included in this study were hematoma, infection, pneumothorax, hemothorax, and death. Using data from the biopsy registry, we evaluated statistically significant risk factors (P<.05) for hematoma related to image-guided liver biopsy, including coagulation status, biopsy technique, and medications.
A total of 49 acute and delayed major adverse events (0.7%) occurred after 6613 liver biopsy events. The incidence of hematoma requiring transfusion and/or angiographic intervention was 0.5% (34 of 6613). The incidence of infection was 0.1% (8 of 6613), and that of hemothorax was 0.06% (4 of 6613). No patient (0%) incurred a pneumothorax after biopsy. Three patients (0.05%) died within 30 days of liver biopsy, 1 being directly related to biopsy. Thirty-eight of 46 major adverse events (83%) presented acutely (within 24 hours). More than 2 biopsy passes, platelets 50,000/μL or less, and female sex were statistically significant risk factors for postbiopsy hemorrhage.
Image-guided liver biopsy performed by subspecialized interventionalists at a tertiary medical center is safe when the platelet count is greater than 50,000/μL. With appreciation of specific risk factors, safety outcomes of this procedure can be optimized in both general and specialized centers.
确定在我们机构12年期间进行的大量影像引导下肝活检相关的主要不良事件发生率，并确定主要出血事件的危险因素。
对内部维护的活检登记册进行回顾性分析。分析显示，2001年12月7日至2013年12月31日期间，5987例成年患者接受了6613次影像引导下肝活检。肝活检采用实时超声引导和弹簧式活检装置，极少数情况除外。本研究中视为主要不良事件包括血肿、感染、气胸、血胸和死亡。利用活检登记册的数据，我们评估了与影像引导下肝活检相关的血肿的统计学显著危险因素（P<0.05），包括凝血状态、活检技术和药物。
6613次肝活检后共发生49例急性和延迟性主要不良事件（0.7%）。需要输血和/或血管造影干预的血肿发生率为0.5%（6613例中的34例）。感染发生率为0.1%（6613例中的8例），血胸发生率为0.06%（6613例中的4例）。活检后无患者发生气胸（0%）。3例患者（0.05%）在肝活检后30天内死亡，1例与活检直接相关。46例主要不良事件中的38例（83%）急性出现（24小时内）。活检穿刺超过2次、血小板计数50,000/μL或更低以及女性是活检后出血的统计学显著危险因素。
在三级医疗中心，由专科介入医生进行的影像引导下肝活检在血小板计数大于50,000/μL时是安全的。认识到特定危险因素后，在综合和专科中心均可优化该操作的安全结果。
