Meng H C, Lin H C, Huang C C, Liao D M, Lee F Y, Lee S D, Tsai Y T, Lo K J
Department of Medicine, Taipei Veterans General Hospital, Taiwan, Republic of China.
J Gastroenterol Hepatol. 1994 Sep-Oct;9(5):457-61. doi: 10.1111/j.1440-1746.1994.tb01274.x.
A transjugular liver biopsy was performed on 60 patients. Specimens were successfully obtained from 57 (95%) patients. Specimens obtained from cirrhotic patients were frequently small-sized/fragmented. The wedge hepatic venous pressure and hepatic venous pressure gradient were higher in patients with small-sized/fragmented specimens than those with non-fragmented specimens (16.3 +/- 6.4 vs 12.3 +/- 4.9 and 10.9 +/- 6.2 vs 7.3 +/- 3.4 mmHg, P < 0.05, respectively). During the same period of time, percutaneous liver biopsies were consecutively performed on 277 patients. The liver specimens by transjugular method were generally smaller (0.63 +/- 0.58 vs 1.50 +/- 0.86 cm, P < 0.001) and more fragmented (63% vs 16%, P < 0.01) than those obtained by percutaneous method. Biopsy specimens obtained for diagnosis by the former method were inadequate from 6 (10%) patients and by the latter route were inadequate from 7 (2%) patients. Subcapsular haematoma in one patient was associated with the transjugular liver biopsy. Minor complications occurred in three patients: neck haematoma in two and paroxysmal supraventricular tachycardia during the procedure in one. In comparison, percutaneous liver biopsy was followed by minor complications in 20 patients and major complications in four patients. It is concluded that transjugular liver biopsy is a safe, valuable and alternative procedure to obtain liver specimens, especially in patients who were contraindicated for percutaneous liver biopsy.
对60例患者进行了经颈静脉肝活检。成功从57例（95%）患者获取了标本。从肝硬化患者获取的标本常常体积小/呈碎片状。标本体积小/呈碎片状的患者的楔形肝静脉压和肝静脉压力梯度高于标本无碎片的患者（分别为16.3±6.4与12.3±4.9以及10.9±6.2与7.3±3.4 mmHg，P均<0.05）。在同一时期，对277例患者连续进行了经皮肝活检。经颈静脉法获取的肝标本通常比经皮法获取的标本更小（0.63±0.58 vs 1.50±0.86 cm，P<0.001）且更破碎（63% vs 16%，P<0.01）。经颈静脉法获取用于诊断的活检标本有6例（10%）患者不合格，经皮法有7例（2%）患者不合格。1例患者出现肝包膜下血肿与经颈静脉肝活检有关。3例患者出现轻微并发症：2例颈部血肿，1例在操作过程中出现阵发性室上性心动过速。相比之下，经皮肝活检后，20例患者出现轻微并发症，4例患者出现严重并发症。结论是，经颈静脉肝活检是获取肝标本的一种安全、有价值的替代方法，尤其适用于经皮肝活检禁忌的患者。
