经颈静脉肝内穿刺活检对不明原因肝病患者的应用价值

The application of transjugular liver biopsy in patients with unexplained liver disease

目的探讨经颈静脉肝内穿刺活检(TJLB)在不明原因肝病合并腹水或凝血功能障碍患者中的临床应用价值。方法回顾性分析2015年3月至2022年1月于郑州大学第一附属医院、周口市中心医院、商丘市第一人民医院、晋城市人民医院接受TJLB的不明原因肝病合并大量腹水或凝血功能障碍患者的临床资料。纳入的37例患者中男性21例,女性16例,年龄(53.5±11.9)岁。按穿刺入针点分为肝右静脉和肝中静脉TJLB两组,对两组肝组织取样效果、穿刺次数、并发症等进行比较。结果37例患者的TJLB成功率为97.3%(36/37),36例患者均有效取得3段以上肝组织并获组织学诊断,病理诊断率100.0%(36/36)。肝右静脉组(21例)的穿刺次数、肝组织条数及汇管区数目依次为(3.7±0.9)次、(3.7±0.7)条、(6.5±0.9)个,肝中静脉组(15例)依次为(3.7±0.7)次、(3.7±0.7)条、(6.3±0.8)个,两组比较差异无统计学意义(均P>0.05)。两组患者均未出现严重并发症。结论TJLB对不明原因肝病伴有腹水或凝血功能障碍患者是安全可行的,从肝右静脉或肝中静脉行TJLB均可获得良好的肝脏组织标本。

Objective To investigate the clinical value of transjugular liver biopsy(TJLB)in patients with unexplained liver disease complicated with massive ascites or coagulopathy.Methods A retrospective analysis was performed from patients underwent TJLB in the First Affiliated Hospital of Zhengzhou University,Zhoukou Central Hospital,Shangqiu First People's Hospital and Jincheng People's Hospital from March 2015 to January 2022 due to unexplained liver disease complicated with massive ascites or coagulopathy.A total of 37 patients were included,including 21 males and 16 females,aged(53.5±11.9)years.According to different puncture points,the patients were divided into two groups:transhepatic right vein TJBL and transhepatic middle vein TJBL.The obtained liver tissue sampling effect,puncture times,complications were analyzed.Results The success rate of TJLB was 97.3%(36/37).Thirty-six patients were able to obtain more than three segments of liver tissue and obtain histological diagnosis,and the pathological diagnosis rate was 100.0%(36/36).The number of puncture times,the amount of hepatic tissue and the number of portal areas in the right hepatic vein group(21 cases)were(3.7±0.9),(3.7±0.7)and(6.5±0.9)respectively,and those in the middle hepatic vein group(15 cases)were(3.7±0.7),(3.7±0.7)and(6.3±0.8)respectively.There were no significant differences between the two groups(all P>0.05).Conclusion TJLB is safe and feasible for patients with unexplained liver disease complicated with massive peritoneal effusion and coagulopathy.Good liver tissue specimens can be obtained by TJLB from both right hepatic vein and middle hepatic vein.