Bilreiro Carlos, Noruegas Maria J, Gonçalves Isabel, Moreira Ângela
*Serviço de Imagem Médica, Polo Hospital Pediátrico †Unidade de Transplantação Hepática, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
J Pediatr Gastroenterol Nutr. 2017 Aug;65(2):137-140. doi: 10.1097/MPG.0000000000001601.
The aim of the study was to analyze the institution's experience in ultrasound-guided liver biopsies performed on children and identify risk factors for complications, following a previous study performed in our institution.
Retrospective analysis of a consecutive series of ultrasound-guided pediatric liver biopsies, between 2011 and 2016. Demographic and anthropometric data, biopsy indications, international normalized ratio (INR) and platelet count, biopsy technique, complications, and pathologic outcomes were recorded.
A total of 228 procedures were performed on 203 children with a median age of 9.25 years (range: 0.08-18.42): 107 girls (47%) and 121 boys (53%). One hundred twenty-seven biopsies were performed on transplanted livers (55.7%) and 101 on native livers (44.3%). There were 27 cases with immediate complications (11.84%), all due to minor bleeding. There were no major complications. Increasing needle passes were shown to be a reliable predictor for bleeding (P = 0.0023), whereas transplanted livers predicted protection against bleeding (P = 0.0007). Age younger than 3 years, bodyweight <16 kg, platelet count <70 g/L and INR >1.25 revealed association with increased bleeding incidence, but no predictive value.
Ultrasound-guided liver biopsies in pediatric age are a safe procedure with a high diagnostic yield. Increasing the number of needle passes predicts a higher incidence of minor bleeding. Other factors to account for minor bleeding risk may include age younger than 3 years, bodyweight <16 kg, platelet count <70 G/L, and INR >1.25. Transplanted livers present a lower bleeding risk.
本研究旨在分析本机构对儿童进行超声引导下肝活检的经验，并在前一项本机构研究的基础上，确定并发症的危险因素。
对2011年至2016年间连续进行的一系列超声引导下小儿肝活检进行回顾性分析。记录人口统计学和人体测量数据、活检指征、国际标准化比值（INR）和血小板计数、活检技术、并发症及病理结果。
共对203名儿童进行了228例手术，中位年龄为9.25岁（范围：0.08 - 18.42岁）：107名女孩（47%）和121名男孩（53%）。对移植肝脏进行了127例活检（55.7%），对天然肝脏进行了101例活检（44.3%）。有27例出现即刻并发症（11.84%），均因轻微出血。无重大并发症。穿刺次数增加被证明是出血的可靠预测因素（P = 0.0023），而移植肝脏则预示着出血风险较低（P = 0.0007）。年龄小于3岁、体重<16 kg、血小板计数<70 g/L和INR>1.25与出血发生率增加相关，但无预测价值。
小儿年龄阶段的超声引导下肝活检是一种安全的操作，诊断率高。穿刺次数增加预示着轻微出血的发生率较高。其他导致轻微出血风险的因素可能包括年龄小于3岁、体重<16 kg、血小板计数<70 G/L和INR>1.25。移植肝脏的出血风险较低。
