Sawyerr A M, McCormick P A, Tennyson G S, Chin J, Dick R, Scheuer P J, Burroughs A K, McIntyre N
Academic Departments of Medicine and Histopathology, Royal Free Hospital and School of Medicine, London, United Kingdom.
J Hepatol. 1993 Jan;17(1):81-5. doi: 10.1016/s0168-8278(05)80525-2.
Patients with liver disease frequently have impaired blood coagulation. The optimal method for liver biopsy in this situation is not established. To investigate this issue we randomised 117 patients with impaired blood coagulation, in whom liver biopsy was required, to receive either transjugular or plugged-percutaneous biopsy. Seventeen patients were excluded prior to biopsy and a protocol biopsy was performed in 100 patients (44 transjugular, 56 plugged-percutaneous). Liver tissue was obtained in 97 (42 transjugular, 55 plugged-percutaneous). Plugged-percutaneous liver biopsy was quicker and easier than transjugular liver biopsy and the biopsies obtained were significantly larger (12 +/- 5 mm vs. 6 +/- 4 mm; p < 0.001). However, 2 of 56 (3.5%) patients who received plugged-percutaneous biopsy had haemorrhage which required transfusion, while none of the 44 patients who received transjugular biopsy had haemorrhage (not significant). Both methods of liver biopsy were associated with a high success rate and a low incidence of complications. Plugged-percutaneous liver biopsy provides larger biopsies but may be associated with an increased risk of haemorrhage.
肝病患者常常存在凝血功能障碍。目前尚未确定在这种情况下进行肝活检的最佳方法。为了研究这个问题，我们将117例需要进行肝活检的凝血功能障碍患者随机分为经颈静脉活检组或经皮穿刺封堵活检组。17例患者在活检前被排除，100例患者（44例经颈静脉活检，56例经皮穿刺封堵活检）进行了方案规定的活检。97例患者（42例经颈静脉活检，55例经皮穿刺封堵活检）获取了肝组织。经皮穿刺封堵肝活检比经颈静脉肝活检更快、更简便，且获取的活检组织明显更大（12±5毫米对6±4毫米；p<0.001）。然而，56例接受经皮穿刺封堵活检的患者中有2例（3.5%）发生了需要输血的出血，而44例接受经颈静脉活检的患者均未发生出血（无显著差异）。两种肝活检方法均具有较高的成功率和较低的并发症发生率。经皮穿刺封堵肝活检可获取更大的活检组织，但可能会增加出血风险。
