超声内镜引导下肝脏穿刺活检术在肝移植受者中的应用价值  

Clinical practice of endoscopic ultrasound-guided liver biopsy among the liver transplant recipients

作　　者：饶伟[1] 李倩[2] 刘佳[2] 田秋菊 张群[1] 蔡金贞 解曼[2] Rao Wei;Li Qian;Liu Jia;Tian Qiuju;Zhang Qun;Cai Jinzhen;Xie Man(Liver Disease Center,Organ Transplantation Center,The Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Gastroenterology,The Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院器官移植中心肝脏病中心,青岛266000 [2]青岛大学附属医院消化内科,青岛266000

出　　处：《中华消化内镜杂志》2024年第2期121-126,共6页Chinese Journal of Digestive Endoscopy

基　　金：2021年度山东省社会科学普及应用研究项目(2021-SKZC-18)。

摘　　要：目的评估超声内镜引导下肝脏穿刺活检术(endoscopic ultrasound-guided liver biopsy,EUS-LB)在肝移植受者病理诊断中的应用价值。方法采用回顾性队列研究设计,在2021年12月至2022年3月间于青岛大学附属医院器官移植中心肝脏病中心因肝功能异常或需要评估肝纤维化程度行EUS-LB的肝移植受者中,选取EUS-LB由同一位内镜医师完成,且标本由同一位病理科医师读片并出具报告的总计12例病例纳入EUS-LB组;在器官移植中心肝脏病中心同期行经皮肝脏穿刺活检术(percutaneous liver biopsy,PLB)的肝移植受者中,选取PLB由同一位肝病内科医师完成,且标本系由EUS-LB组同一位病理科医师读片并出具报告的总计23例病例纳入PLB组。对比2组肝脏组织获取情况和术后不良事件发生情况。结果2组患者均穿刺1~2次。EUS-LB组肝脏组织条的中位总长度明显长于PLB组(61 mm比17 mm,Z=11.362,P=0.002),最长组织条长度稍长于PLB组[(17.6±6.9)mm比(13.7±3.5)mm,t=2.382,P=0.086],肝脏组织条数目明显多于PLB组[(4.8±2.1)条比(2.3±1.2)条,t=9.271,P=0.001],完整汇管区数目明显多于PLB组[(11.3±4.6)个比(6.2±3.3)个,t=8.457,P=0.003]。腹痛是2组术后的唯一不良事件,且EUS-LB组术后腹痛发生率明显低于PLB组[8.3%(1/12)比43.5%(10/23),χ^(2)=4.893,P=0.036]。结论EUS-LB是一种安全有效并且更舒适化的肝脏穿刺活检方法,相比PLB,EUS-LB可以获得更长的组织条和更多的汇管区,并且发生术后疼痛的患者更少,值得临床推广。ObjectiveTo investigate the application of endoscopic ultrasound-guided liver biopsy(EUS-LB)to liver transplant recipients.MethodsIn this retrospective cohort study,a total of 12 liver transplant recipients who underwent EUS-LB by the same endoscopist and specimens were diagnosed and reported by the same pathologist due to abnormal liver function or need to be evaluated for graft fibrosis in the Organ Transplantation Center of the Affiliated Hospital of Qingdao University were enrolled into the EUS-LB group from December 2021 to March 2022,meanwhile,a total of 23 patients whose PLB was completed by the same hepatologist and specimens were diagnosed by the same pathologist during the same period were enrolled in the PLB group.Acquisition of liver specimens and postoperative adverse events of the two groups were compared.ResultsPatients in both groups were punctured 1-2 times on average,and the median total length of liver specimens in the EUS-LB group was significantly longer than that in the PLB group(61 mm VS 17 mm,Z=11.362,P=0.002).There was no significant difference in the length of the longest liver specimens between the two groups(17.6±6.9 mm VS 13.7±3.5 mm,t=2.382,P=0.086),while the number of liver specimens in the EUS-LB group was more than that in the PLB group(4.8±2.1 VS 2.3±1.2,t=9.271,P=0.001).The number of complete portal tracts was 11.3±4.6 in the EUS-LB group and 6.2±3.3 in the PLB group(t=8.457,P=0.003).Abdominal pain was the only postoperative adverse event,and only 1 patient in the EUS-LB group had postoperative abdominal pain,which was fewer than that in the PLB group[8.3%(1/12)VS 43.5%(10/23),χ^(2)=4.893,P=0.036].ConclusionCompared with PLB,EUS-LB delivers longer liver biopsy specimens with more complete portal tracts in liver transplant recipients,and fewer recipients complain about postoperative pain in EUS-LB group.Therefore,EUS-LB is a safer,more effective and more comfortable liver biopsy method.

关 键 词：肝移植 超声内镜引导下肝脏穿刺活检术 经皮肝脏穿刺活检术 湿法 

分 类 号：R657.3[医药卫生—外科学]