Younossi Z M, Teran J C, Ganiats T G, Carey W D
Department of Gastroenterology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Dig Dis Sci. 1998 Jan;43(1):46-50. doi: 10.1023/a:1018815802500.
The use of ultrasound (US) to assist in liver biopsy for nonfocal liver disease has been shown to significantly decrease the incidence of minor complications (defined as pain requiring treatment, hypotension, or bleeding). In this study, decision analysis was used to estimate the average additional net charge for US guidance. The risks for minor and major complications were extracted from the literature. The incidence of minor complications such as pain and bleeding not requiring hospitalization has been reported as 49% for blind liver biopsy and 39% for US-guided liver biopsy. Major complications requiring hospital admission occur in 4% of blind liver biopsies and 2% of US-guided liver biopsies. A decision tree was used to calculate the total charges of liver biopsy and its associated complications. The charge for treating an episode of minor complications was estimated at $605. The charge related to an episode of major complications was estimated at $1533. The total charge for an ultrasound-guided liver biopsy (except the added charge for the use of ultrasound) was $1770, or $102 less than the same charge for blind liver biopsy. The addition of ultrasound in performing liver biopsies for diffuse parenchymal liver disease is cost-saving if the additional charge of US is less than $102.
超声（US）辅助非局灶性肝病肝活检已被证明可显著降低轻微并发症（定义为需要治疗的疼痛、低血压或出血）的发生率。在本研究中，采用决策分析来估计超声引导的平均额外净费用。轻微和严重并发症的风险从文献中提取。据报道，无需住院治疗的疼痛和出血等轻微并发症的发生率，盲目肝活检为49%，超声引导肝活检为39%。需要住院治疗的严重并发症在4%的盲目肝活检和2%的超声引导肝活检中出现。使用决策树来计算肝活检及其相关并发症的总费用。治疗一次轻微并发症的费用估计为605美元。与一次严重并发症相关的费用估计为1533美元。超声引导肝活检的总费用（不包括使用超声的额外费用）为1770美元，比盲目肝活检的相同费用少102美元。如果超声的额外费用低于102美元，在对弥漫性实质性肝病进行肝活检时增加超声检查是节省成本的。
