Lindor K D, Bru C, Jorgensen R A, Rakela J, Bordas J M, Gross J B, Rodes J, McGill D B, Reading C C, James E M, Charboneau J W, Ludwig J, Batts K P, Zinsmeister A R
Mayo Clinic, Rochester, MN 55905, USA.
Hepatology. 1996 May;23(5):1079-83. doi: 10.1002/hep.510230522.
The risk of complications from percutaneous liver biopsy is low, but discomfort is common and complications require hospitalization in approximately 4% of patients. The optimal method of performing these biopsies is unknown. The goal of our study was to determine whether the use of ultrasonography in the biopsy room immediately prior to or during the procedure would lessen the risk of complications and to compare the safety and efficacy in obtaining tissue by use of a Trucut needle versus an automatic biopsy needle. Between 1992 and 1994, 836 patients were entered into a randomized study (489 in Rochester, MN; 347 in Barcelona, Spain). Patients were randomized immediately prior to liver biopsy into four groups: Trucut needle, or automatic biopsy needle, and with or without ultrasonography. Fisher's Exact Test and a logistic regression model were also used to assess the effect of needle and ultrasonography on the odds for complications. The four biopsy groups were well-matched at entry with respect to age, sex, underlying liver disease, hemoglobin, prothrombin time, and platelet count. The use of ultrasound was associated with a decreased rate of hospitalization for pain, hypotension, or bleeding (2 vs. 9, P < .05). No difference in safety was found between the two types of needles. The number of passes needed to obtain specimens was similar for all four groups. The average length of the specimen was slightly greater with ultrasonographic-guided biopsies (1.7 mm vs. 1.6 mm, P < .05) and with biopsies obtained using the automatic biopsy needle when compared with the Trucut needle (1.7 mm vs. 1.5 mm, P < .05), but this did not seem to be clinically important. The addition of ultrasonography reduces complications in patients undergoing percutaneous liver biopsy. The type of needle appears to offer little difference in safety or yield of diagnostic tissue. The use of ultrasonography for guidance of percutaneous liver biopsy will lead to a lower rate of complications. The value of this benefit must be weighed against the added cost of ultrasonographic guidance.
经皮肝穿刺活检的并发症风险较低，但不适较为常见，约4%的患者会因并发症而需住院治疗。目前尚不清楚进行这些活检的最佳方法。我们研究的目的是确定在活检前或活检过程中立即在活检室内使用超声检查是否会降低并发症风险，并比较使用Trucut针与自动活检针获取组织的安全性和有效性。1992年至1994年期间，836例患者进入一项随机研究（明尼苏达州罗切斯特市489例；西班牙巴塞罗那市347例）。患者在肝穿刺活检前立即被随机分为四组：Trucut针组、自动活检针组，以及有无超声检查组。还使用Fisher精确检验和逻辑回归模型来评估针具和超声检查对并发症几率的影响。四个活检组在入组时在年龄、性别、潜在肝脏疾病、血红蛋白、凝血酶原时间和血小板计数方面匹配良好。使用超声检查与因疼痛、低血压或出血而住院的发生率降低相关（2例 vs. 9例，P <.05）。两种针具在安全性上未发现差异。所有四组获取标本所需的穿刺次数相似。超声引导下活检的标本平均长度略长（1.7毫米 vs. 1.6毫米，P <.05），与Trucut针相比，使用自动活检针获取的活检标本平均长度也略长（1.7毫米 vs. 1.5毫米，P <.05），但这在临床上似乎并不重要。增加超声检查可减少经皮肝穿刺活检患者的并发症。针具类型在诊断组织的安全性或获取率方面似乎差异不大。使用超声检查引导经皮肝穿刺活检将降低并发症发生率。必须权衡这种益处的价值与超声引导增加的成本。
