小儿肝穿刺活体组织检查511例临床应用

Clinical application of liver biopsy in children: a report of 511 cases

目的探讨和推动小儿肝穿刺活体组织检查的开展和临床应用。方法对我院小儿肝病科１９８３年～１９９６年５１１例小儿肝活检情况进行回顾性研究。年龄最小１个月，最大１４岁，男∶女为２．６８∶１。均采用一秒钟肝穿法，按１９９５年５月中华传染病与寄生虫学术会议制订的病毒性肝炎病理诊断标准分型。肝穿刺指征如下：（１）原因不明的各种小儿肝病，包括原因不明肝脾肿大。（２）各型慢性病毒性肝炎，病程迁延反复，血清病毒标志持续阳性者。（３）准备实施抗病毒治疗（如干扰素）者。（４）部分重症肝炎。结果本组研究肝活检成功率较高，穿刺率逐年上升。病因中以乙、丙型病毒性肝炎为主，非甲～戊型约占６．５％，非病毒性肝病约占５．１％。结论小儿肝活检术是安全、简便、可行的，只要掌握指征，婴幼儿和年长儿同样成功与安全。通过小儿肝活检术的开展，可将小儿肝病的预防、诊断、治疗工作提高到一个新水平。

Objective To evaluate the value of liver biopsy in children in diagnosis and appropriate treatment of liver diseases. Methods The authors analyzed 511 children underwent needle biopsy of liver in The 302 Hospital from 1983 to 1996. The age of the patients ranged from 1 month to 14 years and female: male ratio was 1∶2.68. The 1 second needle biopsy was applied for each patient. The pathological diagnosis of viral hepatitis was made based on the diagnostic criteria formulated by the Chinese Society of Infections Diseases and Parasitic Diseases in 1995. The indications for liver biopsy were (1) hepatic disease of unknown etiology, including hepatosplenomegaly; (2) recurrent chronic viral hepatitis with continued positive serum viral marks; (3) children who were going to receive antiviral treatment for viral hepatitis; (4) serious hepatitis. Results Hepatitis B and C viruses were the etiologic agents in majority of the cases. 6.5% of the patients had non A～E hepatitis. Non viral hepatitis was found in 5.1% of the cases. Conclusion Liver biopsy in children is a safe, simple and feasible technique as long as the indications of the procedure are well controlled. Proper use of liver biopsy would promote prevention, diagnosis and treatment of hepatic diseases in children.