两种不同方式经皮肝穿刺活组织检查的优缺点分析

doi:10.3969/j.issn.1672-5069.2010.03.003

实用肝脏病杂志 ›› 2010, Vol. 13 ›› Issue (3): 170-171.doi: 10.3969/j.issn.1672-5069.2010.03.003

两种不同方式经皮肝穿刺活组织检查的优缺点分析

王功遂，王曼曼，姜湘宁，明朗，谢秋里，康凯夫，王鹏郑, 张志侨，刘梅华，陈乐无，何杰雄，黄勇，陈晓巧，冼科尔

528300 广东省顺德市第一人民医院感染病科（王功遂,姜湘宁,明朗,谢秋里,王鹏,郑,张志侨,刘梅华,陈乐无,何杰雄,黄勇,陈晓巧,冼科尔）; 病理科（康凯夫）; 中山大学附属第三医院内分泌科（王曼曼）

收稿日期:2010-03-24 出版日期:2010-06-10 发布日期:2016-04-18
作者简介:王功遂男,60岁,主任医师。主要从事病毒性肝炎的临床和病理学研究。E-mail：wgs824@sohu.com

Comparative study of sampling errors of two different percutaneous liver biopsies

WANG Gongsui, WANG Manman, JIANG Xiangning, et al.

Department of Infectious Diseases,the First People’s Hospital,Shunde 528300,Guangdong Province,China

Received:2010-03-24 Online:2010-06-10 Published:2016-04-18
Contact: WANG Gongsui,E-mail:WGS824@sohu.com

摘要/Abstract

摘要： 目的探讨一秒钟负压抽吸法和Bard Magnum切割针自动切割法经皮穿刺肝活检的优缺点。方法在3322例次住院肝病患者肝活检中,分别采用抽吸法3059例次和切割法263例次。对抽吸法获取的标本长度小于1.5cm或为碎片组织的病例行2次或3次肝穿刺;切割法为经皮肤上同一针孔、肝内不同部位连续2次以上肝穿刺,即“一孔多点切割法”。结果抽吸法和切割法肝活检第一针穿刺标本平均长度分别为2.06±0.62cm和1.29±0.50cm（t=17.089,P=0.000）;在221例抽吸法获得碎片组织的慢性乙型肝炎患者中,病理学诊断为肝硬化者184例（83.26%）,对不能诊断为肝硬化的37例患者再行“一孔多点切割法”肝活检,结果35例（94.6%）为肝硬化。结论抽吸法较切割法获取的肝组织多,应作为肝活检的首选方式,肝组织呈碎片标本的慢性乙型肝炎患者大多是肝硬化,“一孔多点切割法”几乎能检出所有的肝硬化患者。

关键词: 经皮穿刺肝活检, 取样误差, 慢性乙型肝炎, 肝硬化

Abstract: Objective To investigate the sampling errors of two different ways of percutaneous liver biopsies. Methods The liver biopsy in 3059 patients were performed by Menghini needle and in 263 patients by automatic Tru-cut needle. Results The average length of samples by Menghini needle were 2.06±0.62cm,longer than by automatic Tru-cut（1.29±0.50cm,t=17.089,P=0.000);In 221 fragmented tissue samples obtained by Menghini,the liver cirrhosis were confirmed in 184 patients（83.26%）;In other 37 patients with fragmented samples without pathological diagnosis at first needle,the second needle by automatic Tru-cut showed liver cirrhosis in 35 patients（94.6%）. Conclusion The samples obtained by Menghini are longer than that by automatic Tru-cut. Nearly all the samples with fragmented tissues by suction needle in patients with hepatitis B are diagnosed as liver cirrhosis.

Key words: Percutaneous liver biopsy, Sampling errors, Hepatitis B, Liver cirrhosis

王功遂，王曼曼，姜湘宁，明朗，谢秋里，康凯夫，王鹏郑, 张志侨，刘梅华，陈乐无，何杰雄，黄勇，陈晓巧，冼科尔. 两种不同方式经皮肝穿刺活组织检查的优缺点分析[J]. 实用肝脏病杂志, 2010, 13(3): 170-171.

WANG Gongsui, WANG Manman, JIANG Xiangning, et al.. Comparative study of sampling errors of two different percutaneous liver biopsies[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2010, 13(3): 170-171.

参考文献

[1] SALEH HA,ABU-RASHED AH. Liver biopsy remains the gold standard for evaluation of chronic hepatitis and fibrosis[J]. J Gastrointestin Liver Dis,2007,16:425-426.
[2] MANNING DS,AFDHAO NH. Diagnosis and quantitation of fibrosis[J]. Gastroenterology,2008,134:1670-1681.
[3] COLLOREDO G,GUIDO M,SONZOGNI A,et al. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis:the smaller the sample,the milder the disease[J]. J Hepatol,2003,39:239-244.
[4] BRAVO AA,SHETH SG,CHOPRA S. Liver biopsy[J]. N Engl J Med,2001,344:495-500.
[5] 病毒性肝炎防治方案（试行）[J]. 中华肝脏病杂志,2000, 8:324-329.
[6] GUIDO M,RUGGE M. Liver biopsy sampling in chronic viral hepatitis[J]. Semin Liver Dis,2004,24:89-97.
[7] SCHEUER PJ. Liver biopsy size matters in chronic hepatitis: bigger is better[J]. Hepatology,2003,38:1356-1358.[8] SPOREA I,POPESCU A,SIRLI R. Why,who and how should perform liver biopsy in chronic liver diseases[J]. World J Gastroenterol,2008,14（21）:3396-3402.
[9] VARGAS T,MARTINEZ V,JIRON MI,et al. Tru-Cut and Menghini needles:different yield in the histological diagnosis of liver disease[J]. Liver,1985,5:178-181.
[10] COLOMBO M,DEL NINNO E,DE FRANCHIS R,et al. Ultrasound-assisted percutaneous liver biopsy: superiority of the Tru-Cut over the Menghini needle for diagnosis of cirrhosis[J]. Gastroenterology,1988,95:487-489.
[11] SPROREA I,POPESCU A,CORRNIANU M,et al. The quality of the fragment obtained by liver biopsy for staging chronic hepatitis[J]. J Gastrointestin Liver Dis,2007,16:263-266.
[12] VAN LEEUWEN DJ,WILSON L,CROWE DR. Liver biopsy in the mid-1990s:questions and answers[J]. Semin Liver Dis,1998,15:340-359.
[13] GILMORE IT,BURROUGHS A,MURRA-LYON IM,et al.Indications,methods and outcomes of percutaneous liver biopsy in England and Wales:an audit by the British society of Gastroenterology and the Royal collage of physicians of London[J]. Gut,1995,36:437-441.
[14] RILEY TR. How often does ultrasound marking change the liver biopsy site[J]. Am J Gastroenterol,1994,94:3320-3322.
[15] BEDOSSA P,DARGERE D,PARADIS V. Sampling variability of liver fibrosis in chronic hepatitis C[J]. Hepatology,2003,38:1449-1457.
[16] BRUNETTI E,SILINI E,PISTORIO A,et al. Coarse vs. fine needle aspiration biopsy for the assessment of diffuse liver disease from hepatitis C virus-related chronic hepatitis[J]. J Hepatol,2004,40:501-506.
[17] 王功遂,姜湘宁,明朗,等. 两种肝活组织检查方式的临床应用[J]. 中华肝脏病杂志,2009,17:135-136.
[18] PETZ D,KLAUCK S,ROHL FW. Feasibility of histological grading and staging of chronic viral hepatitis using specimens obtained by thin-needle biopsy[J]. Virchows Arch,2003,442（3）:238-244.
[191] MALIK AH,KUMAR KS,MALET PF,et al. Correlation of percutaneous liver biopsy fragmentation with the degree of fibrosis[J]. Aliment Pharmacol Ther,2004,19:545-549.
[20] PONIACHIK J,BEMSTEIN DE,REDDY KR,et al. The role of laparoscopy in the diagnosis of cirrhosis[J].Gastrointest Endosc,1996,43:568-571.

两种不同方式经皮肝穿刺活组织检查的优缺点分析

Comparative study of sampling errors of two different percutaneous liver biopsies

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	庄莹, 林志辉. 肝硬化并发门静脉血栓临床表现和诊断进展[J]. 实用肝脏病杂志, 2019, 22(6): 765-767.
[2]	朱凌云, 张茂海, 崔莎莎, 张秋萍. 慢性乙型肝炎患者血清IL-12、IL-18水平和外周血单个核细胞FOXp3基因水平研究^*[J]. 实用肝脏病杂志, 2019, 22(6): 816-819.
[3]	石莹莹, 王元喜. 替比夫定联合阿德福韦酯治疗慢性乙型肝炎患者效果及其对肾功能的影响^*[J]. 实用肝脏病杂志, 2019, 22(6): 820-823.
[4]	闵峰, 黄文琪, 吴卫兵, 张丽, 范荣华. 慢性乙型肝炎患者血清脂肪细胞因子水平变化及其临床意义^*[J]. 实用肝脏病杂志, 2019, 22(6): 824-827.
[5]	张迎明, 申爽, 田飞, 孙园园. IFNL4和IL-28B基因多态性检测评估慢性乙型肝炎患者抗病毒治疗应答价值分析^*[J]. 实用肝脏病杂志, 2019, 22(6): 828-831.
[6]	杨才勇, 陈娜, 李奎, 江自成, 卜蓉蓉. 慢性丙型肝炎和丙型肝炎肝硬化患者外周血Treg和Th17水平变化临床意义探讨^*[J]. 实用肝脏病杂志, 2019, 22(6): 868-871.
[7]	朱娅鸽, 刘锦峰. 丁二磺酸腺苷蛋氨酸联合复方甘草酸苷治疗酒精性肝硬化患者疗效及其对血清BGP水平的影响^*[J]. 实用肝脏病杂志, 2019, 22(6): 872-875.
[8]	武丹, 马向鹰. 非酒精性脂肪性肝病肝硬化患者胰岛素抵抗水平与颈动脉硬化程度和左心室功能研究^*[J]. 实用肝脏病杂志, 2019, 22(6): 876-879.
[9]	陈梅梅, 段晓燕, 曹海霞, 丁雯瑾. 复方鳖甲软肝片治疗原发性胆汁性肝硬化患者疗效分析^*[J]. 实用肝脏病杂志, 2019, 22(6): 880-883.
[10]	刘李, 杨烈, 陈海洋, 何承俊, 王建宇, 陈廷昊. 肝硬化门静脉高压症并发脾动脉盗血综合征患者脾切除联合贲门周围血管离断术后门脉血流动力学的变化^*[J]. 实用肝脏病杂志, 2019, 22(6): 884-887.
[11]	何志安, 余丽萍, 赖江琼, 黄思付. ARFI评估肝硬化并发食管胃底静脉曲张患者出血和门静脉血栓的价值分析^*[J]. 实用肝脏病杂志, 2019, 22(6): 888-891.
[12]	李传杰, 徐静, 王亮亮, 潘劲劲, 刘波. 恩替卡韦治疗慢性乙型肝炎患者血清HBsAg变化与病毒学应答的相关性研究[J]. 实用肝脏病杂志, 2019, 22(6): 928-929.
[13]	赵协山, 伍春瑢, 王春峰, 余积洁, 何青. 替诺福韦联合安络化纤丸治疗HBeAg阴性慢性乙型肝炎患者疗效及其血清肝纤维化指标的变化研究*[J]. 实用肝脏病杂志, 2019, 22(5): 644-647.
[14]	涂杰霞, 王安娜, 廖若汐. 干扰素α-2b与聚乙二醇干扰素α-2a治疗慢性乙型肝炎患者疗效比较研究*[J]. 实用肝脏病杂志, 2019, 22(5): 648-651.
[15]	高伟, 侯勇. 肝脏硬度值检测诊断慢性乙型肝炎患者肝组织纤维化的效能分析*[J]. 实用肝脏病杂志, 2019, 22(5): 652-655.