经颈静脉穿刺肝组织活检操作要点及并发症分析*

doi:10.3969/j.issn.1672-5069.2025.02.033

实用肝脏病杂志 ›› 2025, Vol. 28 ›› Issue (2): 290-293.doi: 10.3969/j.issn.1672-5069.2025.02.033

经颈静脉穿刺肝组织活检操作要点及并发症分析^*

朱帝文, 张媛, 鲍应军, 顾俊鹏, 孙丽华, 任伟新

830054 乌鲁木齐市新疆医科大学第一附属医院介入放射科(朱帝文,张媛,鲍应军,顾俊鹏,孙丽华,任伟新);附属肿瘤医院超声诊断科(张媛)

收稿日期:2024-07-04 出版日期:2025-03-10 发布日期:2025-03-11
通讯作者: 任伟新,E-mail:rwx1031@163. com
作者简介:朱帝文,男,40 岁,博士研究生,副主任医师。主要从事综合介入诊断与治疗学研究。E-mail:baodazi@126.com
基金资助:
^*新疆维吾尔自治区“天池英才”青年博士基金资助项目(编号:2020001)

Transjugular liver biopsy in patients with creptogenic liver diseases

Zhu Diwen, Zhang Yuan, Bao Yingjun, et al

Department of Interventional Radiology, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China

Received:2024-07-04 Online:2025-03-10 Published:2025-03-11

摘要/Abstract

摘要： 目的总结经颈静脉肝组织活检检查的操作要点及其并发症发生情况,为临床提供经验。方法 2023年12月～2024年5月我院诊治的不明原因的肝硬化或肝功能指标异常患者47例,均接受经颈静脉肝穿刺活检(TJLB)术,总结手术操作要点和并发症发生情况。结果所有患者(100.0%)完成TJLB手术操作;取得肝组织1～5条,平均为3.0±0.9 条;每条0.2～2.5 cm,平均为1.1±0.4 cm;镜下可见汇管区2～24个,平均为7.8±4.9个;组织学检查结合血清学检测,诊断自身免疫性肝炎(AIH)13例,结节性肝硬化(病因不明)6例,因取得的组织过少,无法诊断4例,原发性胆汁性胆管炎(PBC)4例,药物性肝损伤3例,结蹄组织增生3例,脂肪肝2例,慢性肝病(病因不明)2例,肝细胞点状坏死2例,AIH-PBC重叠综合征(OS)2例,非硬化性特发性门脉高压1例,门静脉海绵样变性1例,小胆管增生1例,散在炎症细胞浸润1例,非酒精性脂肪性肝炎1例和未见组织学异常1例;术后出现肝包膜下出血1例(2.1%)。结论在特殊病例,采取TJLB术可以帮助明确诊断,值得尝试。

关键词: 慢性肝病, 经颈静脉肝穿刺活检, 操作要点, 并发症, 诊断

Abstract: Objective The aim of this study was to investigate application of transjugular liver biopsy (TJLB) in patients with creptogenic liver diseases. Methods Fouty-seven patients with creptogenic liver diseases were encountered in our hospital between December 2023 and May 2024, and all underwent TJLB for histo-pathological examination. The key operating points and possible complications were summarized. Results All patients (100.0%)completed the operation; the obtained liver tissues were one to five bars, average of 3.0±0.9 bars, with 0.2 to 2.5 cm (average:1.1±0.4 cm); under microscopy, 2 to 24 portal areas were found (average:7.8±4.9); with combination of serology study, the histo-pathological examination diagnosed autoimmune hepatitis (AIH)in 13 cases, creptogenic nodular liver cirrhosis in 6 cases, unavailable diagnosis because of too little tissues in 4 cases, primary biliary cholangitis (PBC) in 4 cases, drug-induced liver injury (DILI) in 3 cases, connective tissue hyperplasia(CTH) in 3 cases, fatty liver in 2 cases, creptogenic liver diseases in 2 cases, hepatocyte spotty necrosis in 2 cases, AIH-PBC overlapping syndrome (OS)in 2 cases, idiopathic non-cirrhotic portal hypertension in 1 case,cavernous transformation of the portal vein (CTPV) in 1 case, small bile duct hyperplasia in 1 case, scattered inflammatory cell infiltration in 1 case, nonalcoholic steatohepatitis (NASH) in 1 case and normal liver tissue manifestation in 1 case; 1 patient (2.1%)developed subcapsular hemorrhage after the operation and recovered by appropriate management. Conclusion Transjugular liver biopsy is an alternative useful approach to obtain liver tissue samples, which might helpful to determine diagnosis for clinicians to make an early management.

Key words: Creptogenic liver diseases, Transjugular liver biopsy, Key points of protocol, Complications, Diagnosis

朱帝文, 张媛, 鲍应军, 顾俊鹏, 孙丽华, 任伟新. 经颈静脉穿刺肝组织活检操作要点及并发症分析^*[J]. 实用肝脏病杂志, 2025, 28(2): 290-293.

Zhu Diwen, Zhang Yuan, Bao Yingjun, et al. Transjugular liver biopsy in patients with creptogenic liver diseases[J]. Journal of Practical Hepatology, 2025, 28(2): 290-293.

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经颈静脉穿刺肝组织活检操作要点及并发症分析^*

Transjugular liver biopsy in patients with creptogenic liver diseases

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