Iqbal M, Creger R J, Fox R M, Cooper B W, Jacobs G, Stellato T A, Lazarus H M
Department of Medicine, Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, OH 44106, USA.
Bone Marrow Transplant. 1996 Apr;17(4):655-62.
Hepatic dysfunction is common in patients who receive intensive chemotherapy and it is important to determine the etiology in order to institute appropriate therapy. The role of laparoscopic liver biopsy in patients with neutropenia, thrombocytopenia, or both was evaluated as a mean of making treatment decisions and as a determinant of clinical outcome. Laparoscopic liver biopsy was performed in 29 subjects who were receiving intensive cytotoxic therapy with or without bone marrow transplantation. One to three direct-vision laparoscopic liver biopsies were performed in each patient using a Tru-cut needle during general anesthesia. Platelet concentrate transfusions were usually given before, during, and immediately after biopsy. Bleeding was controlled with spatula electrocautery. Thirty-two biopsies were obtained in 29 patients. At the time of liver biopsy, white blood cell and platelet counts ranged from 0 to 14,300/microliters (median: 2500/microliters), and 1000 to 47,000/microliters (median: 20,000/microliters), respectively. Bleeding at the liver biopsy site was readily controlled during the procedure without clinical evidence of significant bleeding; no procedure-related complications were noted and no patients required re-exploration. All biopsies were informative and the lesions observed in 32 biopsies revealed graft-versus-host disease (n = 5), hepatic candidiasis (n =1), hepatic veno-occlusive disease (n = 3), cholestasis (n = 19), hemosiderosis (n = 26), toxic injury (n = 8), hepatic steatosis (n = 4), granuloma (n = 1), viral infection (n =1), and malignancy (n = 1). Laparoscopic liver biopsy has been proven to be an effective means of assessing the cause of liver dysfunction in patients who were thrombocytopenic and immunosuppressed. The diagnosis obtained at laparoscopic liver biopsy altered therapy in nine of 29 (31%) patients.
肝功能障碍在接受强化化疗的患者中很常见，确定病因对于制定适当的治疗方案很重要。评估了腹腔镜肝活检在中性粒细胞减少、血小板减少或两者兼有的患者中的作用，以此作为做出治疗决策的一种手段和临床结果的决定因素。对29名正在接受强化细胞毒性治疗（无论是否进行骨髓移植）的受试者进行了腹腔镜肝活检。在全身麻醉下，使用Tru-cut针为每位患者进行1至3次直视下腹腔镜肝活检。通常在活检前、活检期间和活检后立即输注浓缩血小板。用刮匙电灼控制出血。29例患者共获得32次活检标本。肝活检时，白细胞计数和血小板计数分别为0至14,300/微升（中位数：2500/微升）和1000至47,000/微升（中位数：20,000/微升）。肝活检部位的出血在手术过程中很容易得到控制，没有明显出血的临床证据；未发现与手术相关的并发症，也没有患者需要再次手术探查。所有活检标本均提供了有用信息，32次活检中观察到的病变包括移植物抗宿主病（n = 5）、肝念珠菌病（n =1）、肝静脉闭塞病（n = 3）、胆汁淤积（n = 19）、含铁血黄素沉着症（n = 26）、毒性损伤（n = 8）、肝脂肪变性（n = 4）、肉芽肿（n = 1）、病毒感染（n =1）和恶性肿瘤（n = 1）。腹腔镜肝活检已被证明是评估血小板减少和免疫抑制患者肝功能障碍原因的有效手段。在29例患者中有9例（31%），腹腔镜肝活检所获得的诊断改变了治疗方案。
