Transjugular Liver Biopsy: Safe Even in Patients With Severe Coagulopathies and Multiple Biopsies
Transjugular Liver Biopsy: Safe Even in Patients With Severe Coagulopathies and Multiple Biopsies
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DOI：
10.14309/ctg.0000000000000063
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发表时间：
2019-07-01
影响因子：
3.6
通讯作者：
Kee, Stephen T.
中科院分区：
文献类型：
--
作者：
Sue, Megan J.;Lee, Edward W.;Kee, Stephen T.
目的：研究经颈静脉肝活检（TJLB）的安全性和诊断有效性，重点关注严重凝血功能障碍和多次活检的患者。收集了1，932例患者中的321例TJLB（平均年龄43.5 ± 23.2岁）在2009年1月至2017年5月期间进行，以确定活检后3天和30天内的诊断成功率以及重大和轻微并发症的发生率。这些结果也进行了分析，严重凝血病患者和一个亚组的患者进行多次活检。结果：TJLB程序的总体成功率（诊断率）为97.7%（1,291/1,321）。总体而言，严重和轻微并发症发生率分别为1.0%（13/1，321）和9.5%（126/1，321）。在多次活检的患者中，总体并发症发生率与整个研究队列相似，为10.4%（57/550）。患者还根据血小板计数0-50、51-100、101-200、201-300和> 300 × 10（3）血小板/μ L进行分层。总体并发症发生率分别为8.0%（10/124）、11.6%（36/310）、9.9%（54/547）、11.9%（28/235）和14.3%（11/77），彼此之间无统计学意义。患者还通过国际标准化比率分为0-1、1.1-2、2.1-3和> 3。这些患者的总体并发症发生率分别为8.0%（19/237）、11.8%（113/954）、16.3%（7/43）和0%（0/9），彼此之间无统计学意义。它可以安全地在同一患者或危重、严重凝血病患者中多次进行，并发症发生率不会显著增加，同时保持非常有利的诊断率。
OBJECTIVES: To investigate the safety profile and diagnostic efficacy of transjugular liver biopsy (TJLB), with a focus on patients with severe coagulopathies and with multiple biopsies.METHODS: Clinical, laboratory, and demographic information was collected on 1,321 TJLBs in 932 patients (mean age 43.5 +/- 23.2 years) performed between January 2009 and May 2017 to determine the diagnostic success rate and incidence of both major and minor complications in the 3-day and 30-day period postbiopsies. These outcomes were also analyzed for severely coagulopathic patients and a subgroup of patients who underwent multiple biopsies.RESULTS: The overall success rate (diagnostic yield) of the TJLB procedure was 97.7% (1,291/1,321). Overall, the major and minor complication rates were 1.0% (13/1,321) and 9.5% (126/1,321), respectively. In patients with multiple biopsies, the overall complication rate was similar to the entire study cohort, which was 10.4% (57/550). Patients were also stratified according to the platelet counts of 0-50, 51-100, 101-200, 201-300 and > 300 x 10(3) platelets/mu L. The overall complication rates were 8.0% (10/124), 11.6% (36/310), 9.9% (54/547), 11.9% (28/235), and 14.3% (11/77), respectively, and these were not statistically significant from each other. Patients were also stratified by international normalized ratio into 0-1, 1.1-2, 2.1-3, and > 3. The overall complication rates of these patients were 8.0% (19/237), 11.8% (113/954), 16.3%(7/43), and0%(0/9), respectively, andwere not statistically significant fromeach other.DISCUSSION: TJLB is a highly efficacious, well-tolerated and safe procedure. It can be safely performed multiple times in the same patient or in critically ill, severely coagulopathic patients with no significant increase in the rate of complication while maintaining an extremely favorable diagnostic yield.