Controversies in liver biopsy: who, where, when, how, why?
Controversies in liver biopsy: who, where, when, how, why?
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DOI：
10.1007/s11894-004-0023-4
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发表时间：
2004-02-01
影响因子：
--
通讯作者：
Friedman, Lawrence S
中科院分区：
文献类型：
--
作者：
Friedman, Lawrence S
肝活检仍然在评估疑似肝病患者中发挥核心作用。该程序通常用于评估无法解释的肝脏生化检查异常，但血清转氨酶升高的确切程度应提示肝活检是有争议的，因为所有疑似非酒精性脂肪肝和慢性丙型肝炎患者都需要肝活检。标准肝活检禁忌于有严重凝血障碍和腹水的患者，尽管对禁忌肝活检的凝血障碍程度存在争议。经颈静脉入路是凝血功能障碍或腹水患者的一种替代方法。围绕肝活检的所有技术方面都存在争议，特别是针的选择（切割与抽吸）以及使用超声标记或引导活检部位。出血是肝活检的主要并发症，风险为0.3%;切割针比吸引针更容易引起出血。传统上，肝活检一直是肝病学家/胃肠病学家的领域。然而，越来越多的肝活检是由放射科医生进行的。这种趋势对患者结局、安全性和研究员培训的影响尚不清楚。
Liver biopsy continues to have a central role in the evaluation of patients with suspected liver disease. The procedure is often indicated to evaluate otherwise unexplained liver biochemical test abnormalities, but the precise degree of serum aminotransferase elevations that should prompt a liver biopsy is controversial, as is the need for liver biopsy in all patients with suspected nonalcoholic fatty liver disease and chronic hepatitis C. Standard liver biopsy is contraindicated in patients with severe coagulopathy and ascites, although the degree of coagulopathy that contraindicates a liver biopsy is controversial. A transjugular approach is an alternative in patients with coagulopathy or ascites. Controversy surrounds all the technical aspects of liver biopsy, particularly the choice of needle (cutting vs suction) and the use of ultrasound to mark or guide the biopsy site. Bleeding is the major complication of liver biopsy, with a risk of 0.3%; cutting needles are more likely to cause hemorrhage than are suction needles. Traditionally, liver biopsy has been the province of the hepatologist/ gastroenterologist. However, an increasing number of liver biopsies are performed by radiologists. The implications of this trend with respect to patient outcome, safety, and training of fellows is unclear.