超声引导穿刺活检对肝纤维化的诊断价值分析

Ultrasound-guided biopsy in diagnosis of liver fibrosis

目的探究超声引导下经皮肝脏穿刺活检在肝脏纤维化诊断的临床应用价值。方法选择在解放军第九六O医院泰安医疗区接受经皮肝脏穿刺活检术的265例肝脏病变患者作为研究对象,依次对患者实施瞬间弹性成像检查和超声引导下经皮肝脏穿刺活检,观察超声引导下经皮肝脏穿刺活检的穿刺成功率、穿刺时间、穿刺次数、生命体征指标等,比较瞬间弹性成像检查、超声引导下经皮肝脏穿刺活检对不同肝脏病变类型、不同肝脏纤维化分期的诊断符合率。结果超声引导下经皮肝脏穿刺的首次穿刺成功率为94.34%,单次穿刺时间(39.85±&31)s,总穿刺时间分别(77.14±15.26)s,穿刺次数为(1.17±0.54)次,穿刺前、穿刺后的心率、平均动脉压比较均差异无统计学意义(P>0.05)。超声引导下经皮肝脏穿刺活检对乙型肝炎肝硬化、丙型肝炎肝硬化的诊断符合率均高于瞬间弹性成像检查(P<0.05),2种检查方法对酒精性脂肪肝、非酒精性脂肪肝、原发性胆汁性肝硬化、自身免疫性肝病、不明原因肝损伤的诊断符合率比较差异均无统计学意义(P>0.05)。超声引导下经皮肝脏穿刺活检对肝脏纤维化S1期、S2期、S3期、S4期的诊断符合率均高瞬间弹性成像检查(P<0.05)。结论超声引导下经皮肝穿刺活检在肝脏病变诊断中可以提高诊断肝纤维化进程的准确性,具有较高的临床诊断价值。

Objective To explore the clinical applicability of ultrasound-guided percutaneous liver biopsy.Methods Two hundred and sixty-five patients with liver lesions who underwent percutaneous liver biopsy in No.960 Hospital of Chinese PLA were selected as the subjects,who were successively examined by FibroScan and ultrasound-guided percutaneous liver biopsy.The success rate,puncture time,number of times of puncture and vital signs related to percutaneous ultrasound-guided liver biopsy were observed.The diagnostic accuracy of FibroScan and ultrasound guided percutaneous liver biopsy in different types of liver lesions and stages of liver fibrosis was compared.Results The success rate of the first puncture was 94.34%,the single puncture time and total puncture time were(39.85±8.31)s and(77.14±15.26)s respectively,and the number of times of puncture was(1.17±0.54).There was no significant change in heart rate and average arterial pressure after puncture(P>0.05).The diagnostic accuracy of ultrasound-guided percutaneous liver biopsy for hepatitis B cirrhosis and hepatitis C cirrhosis was higher than that of FibroScan(P<0.05),but there was no significant difference between the two methods in the diagnosis of alcoholic fatty liver,non-alcoholic fatty liver,primary biliary cirrhosis,autoimmune liver disease or unknown liver injury(P>0.05).The diagnostic accuracy of ultrasound-guided percutaneous liver biopsy in SI,S2,S3 and S4 stages of liver fibrosis was higher than that of FibroScan(PV0.05).Conclusion Percutaneous liver biopsy under the guidance of ultrasound can improve the accuracy of liver fibrosis and is of higher diagnostic value.