Ribeiro A, Reddy R, Bernstein D E, Roth D, Jeffers L, Schiff E R
Center for Liver Diseases, University of Miami, School of Medicine, FL 33136, USA.
Gastrointest Endosc. 1997 Jun;45(6):503-7. doi: 10.1016/s0016-5107(97)70181-0.
Diagnostic laparoscopy with liver biopsy has been shown to be safe and effective in the evaluation of patients with chronic liver disease. Patients with end-stage renal disease may be more prone to bleeding complications secondary to liver biopsy as a result of multiple factors directly related to their underlying renal condition.
From January 1994 to June 1996, 16 patients with end-stage renal disease and hepatic dysfunction (6 women and 10 men) underwent diagnostic laparoscopy with liver biopsy prior to renal transplantation at the University of Miami School of Medicine. Laparoscopy was performed using a 5 mm video laparoscope with a left paramedian approach. The mean patient age was 46 years. Fourteen patients had chronic hepatitis C with a reactive anti-HCV by ELISA; one patient had chronic hepatitis B with reactive HBsAg, and one patient was co-infected with both hepatitis B and C viruses.
Two patients developed hypotension related to the procedure and one patient developed an intra-abdominal hemorrhage 5 days after laparoscopy that did not require surgical intervention. Biopsy findings were as follows: 13 patients had mild chronic hepatitis; 2 patients had chronic hepatitis with bridging fibrosis; and 1 patient was cirrhotic. Prior kidney transplantation or peritoneal dialysis did not preclude the performance of laparoscopy.
Diagnostic laparoscopy can be safety performed in patients with end-stage renal disease with acceptable morbidity and mortality.
诊断性腹腔镜检查联合肝活检已被证明在评估慢性肝病患者时是安全有效的。终末期肾病患者由于与其潜在肾脏疾病直接相关的多种因素，可能更容易在肝活检后出现出血并发症。
1994年1月至1996年6月，16例终末期肾病合并肝功能不全的患者（6例女性，10例男性）在迈阿密大学医学院接受肾移植前进行了诊断性腹腔镜检查联合肝活检。使用5毫米视频腹腔镜经左正中旁入路进行腹腔镜检查。患者平均年龄为46岁。14例患者慢性丙型肝炎，ELISA检测抗-HCV反应阳性；1例患者慢性乙型肝炎，HBsAg反应阳性，1例患者同时感染乙型和丙型肝炎病毒。
2例患者在手术过程中出现低血压，1例患者在腹腔镜检查后5天出现腹腔内出血，但无需手术干预。活检结果如下：13例患者为轻度慢性肝炎；2例患者为慢性肝炎伴桥接纤维化；1例患者为肝硬化。既往肾移植或腹膜透析并不妨碍进行腹腔镜检查。
诊断性腹腔镜检查可安全地用于终末期肾病患者，其发病率和死亡率可接受。
