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Application of transjugular liver biopsy in the diagnosis and treatment of complicated and severe liver diseases
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摘要:
目的 探讨经颈静脉肝穿刺活检(TJLB)在疑难重症肝病诊断及治疗中应用的意义。 方法 回顾性分析2016年1月-2021年5月在解放军总医院第五医学中心接受TJLB的31例患者的临床资料，对穿刺的适应证、成功率、最终诊断结果进行分析。 结果 31例患者中男15例，女16例。8例因肝衰竭凝血机制障碍、13例因肝硬化合并腹水、10例因肝硬化合并血小板减少(＜50×109/L)不宜行经皮肝穿刺活检，符合实施TJLB适应证。TJLB穿刺成功率100%，穿刺条数2~4条。无严重不良事件。患者出院明确诊断26例(83.87%)。其中特发性门静脉高压5例，药物性肝衰竭或肝硬化9例，自身免疫性肝病5例，其他原因肝硬化或肝衰竭7例，尚不能明确病因者5例，此外，为证实诊断及决策是否肝移植患者3例。 结论 TJLB在疑难重症肝病诊治中发挥重要作用，但尚有一定局限性，临床上应注意筛选适宜患者实施。 Abstract:Objective To investigate the application value of transjugular liver biopsy (TJLB) in the diagnosis and treatment of complicated and severe liver diseases. Methods A retrospective analysis was performed for the clinical data of 31 patients who underwent TJLB in The Fifth Medical Center of Chinese PLA General Hospital, including indication for puncture, success rate, and final diagnosis. Results Among the 31 patients, there were 15 male patients and 16 female patients. Percutaneous liver biopsy was unsuitable for 8 patients with liver failure and disturbances of blood coagulation, 13 with liver cirrhosis and ascites, and 10 with liver cirrhosis and thrombocytopenia (< 50×109/L), which were the indications for TJLB. The success rate of TJLB puncture was 100%, with 2-4 passes for puncture. No serious adverse event was observed. Of all 31 patients, 26 (83.87%) had a definite diagnosis at discharge, among whom there were 5 patients with idiopathic portal hypertension, 9 patients with drug-induced liver failure or liver cirrhosis, 5 patients with autoimmune liver disease, and 7 patients with liver cirrhosis or liver failure due to other causes, and 5 patients had unknown etiology. In addition, 3 patients underwent biopsy to confirm the diagnosis and decision of whether liver transplantation should be performed. Conclusion TJLB plays an important role in the diagnosis and treatment of complicated and severe liver diseases and still has certain limitations, and therefore, suitable patients should be selected in clinical practice. -
Key words:
- Liver Diseases /
- Biopsy, Needle /
- Diagnosis /
- Therapeutics
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注: a，汇管区内门静脉壁厚，部分肝窦轻度扩张，未见肝硬化表现(HE染色，×200);b，肝硬化，Laennec分期F4C(HE染色，×100);c，假小叶形成(肝硬化)，明显的融合状坏死和桥接坏死，大量的炎性细胞浸润，界面炎明显(HE染色，×10);d，肝窦充满均质粉染物，肝细胞萎缩消失，偏振光下呈苹果绿折光性(右上，刚果红)(HE染色，×400);e，汇管区中度混合性炎细胞浸润，固有胆管尚存，周边细胆管反应增生，有的细胆管扩张含胆栓(HE染色，×200);f，亚急性肝炎，重度肝内淤胆，肝细胞及毛细胆管淤胆易见(HE染色，×10)。
图 1 部分患者肝活检病理结果
表 1 患者相关化验指标
指标 数值 Alb(g/L) 33.00(28.00~37.00) ALT(U/L) 33.00(18.00~63.00) AST(U/L) 49.00(35.00~140.00) ALP(U/L) 149.00(84.00~266.00) GGT(U/L) 98.00(27.00~156.00) TBil(μmol/L) 57.30(18.10~164.60) PTA(%) 52.90(42.90~70.60) INR 1.37(1.13~1.58) WBC(×109/L) 3.38(2.14~5.30) Hb(g/L) 105.00(93.00~124.00) PLT(×109/L) 68.00(47.00~118.00) 注：数据描述方式为M (P25~P75)。 
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