Division of Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Department of Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Indian J Pediatr. 2021 Jul;88(7):709-711. doi: 10.1007/s12098-020-03650-z. Epub 2021 Feb 2.
Transjugular liver biopsy (TJLB) is widely used in adults when percutaneous liver biopsy (PLB) is contraindicated. The authors evaluated the safety, efficacy and utility of TJLB in pediatric patients with contraindications to PLB. Twenty-three children and adolescents (13 male) underwent 24 (one patient had two separate biopsies) consecutive biopsies (TJLB) under general anaesthesia (18) or intravenous sedation (6). PLB was contraindicated because of elevated prothrombin time (PT)/international normalized ratio (INR) (˃ 15.5/1.5) in 19 (79.2%) and thrombocytopenia (< 60,000/dL) in 15 (62.5%) procedures. Derangement in both INR and platelet count were found in 12 (50%) cases. Significant ascites was present in 10 (41.7%) procedures. Technical success rate with adequate biopsy sample was 95.8% (23/24) with no major complications. A new diagnosis was established in 9 (37.5%) cases. Another 14 (58.34%) biopsies confirmed the initial diagnoses. Four cases also revealed additional information guiding overall management and prognosis. Thus, TJLB is a safe and useful procedure in children.
经颈静脉肝活检（TJLB）在经皮肝活检（PLB）禁忌时广泛用于成人。作者评估了 TJLB 在 PLB 禁忌的儿科患者中的安全性、疗效和实用性。23 名儿童和青少年（13 名男性）在全身麻醉（18 名）或静脉镇静（6 名）下进行了 24 次（一名患者进行了两次单独的活检）连续活检（TJLB）。19 次（79.2%）因凝血酶原时间（PT）/国际标准化比值（INR）升高（>15.5/1.5）和 15 次（62.5%）血小板计数<60,000/dL 而禁忌 PLB。12 例（50%）存在 INR 和血小板计数均异常。10 例（41.7%）存在大量腹水。23 次活检中有 23 次（95.8%）获得了足够的活检样本，技术成功率高，且无重大并发症。9 例（37.5%）建立了新的诊断。另外 14 次活检（58.34%）证实了最初的诊断。4 例还揭示了其他信息，指导了整体管理和预后。因此，TJLB 在儿童中是一种安全且有用的方法。
