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经皮肝活检、细针抽吸肝活检和腹腔镜肝活检

Authors
Arturo Bravo, MD
Sunil G Sheth, MD
Sanjiv Chopra, MD, MACP
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
许树长, 主任医师，教授

引言

首例经皮肝脏活检于1883年在德国实施[1]。然而，该技术需要长达15分钟的肝内期，使其不切实际且可能并不安全。1958年Menghini报道了一种快速“一秒钟肝脏穿刺活检”技术，此后该操作得到了更广泛的应用[2]。

组织活检的病理学检查可提供其他手段所不能提供的下述定性信息，即肝脏结构完整性以及损伤和/或纤维化的类型与程度[3]。(参见“慢性肝病的组织学评分系统”)该方法也有益于监测治疗效果，并可用于肿瘤确诊。

通常仅在肝生化检查指标长期(超过6个月)升高的患者接受透彻的非侵入性临床评估之后实施肝脏活检。(参见“肝生化和肝功能试验异常患者的评估”)相关临床信息应该提供给病理学医生，从而使病理组织学结果能够结合恰当的临床背景进行解读[4]。

有数种方法可以获取肝组织：经皮、经颈静脉、腹腔镜、超声或计算机断层扫描(computed tomography, CT)引导下的细针抽吸活检(fine-needle aspiration, FNA)。每种方法都存在固有优势和弊端。选择某种特定技术的决策依据是现有专业知识和特定临床情况。

  • 常规经皮肝脏活检是现代医疗实践中最简单、最快捷且最常见的实施方法，经验丰富者操作非常安全。
  • FNA提供少量细胞用于细胞学检查；因此并不是真正的组织活检。常用于某处特定病灶的采样。
  • 肝硬化患者采用腹腔镜下肝脏活检的诊断阳性率可能高于经皮肝脏活检，而存在各种腹内恶性肿瘤的患者采用腹腔镜下肝脏活检能够很好地实现病变程度的分期。然而，该方法需要全身麻醉，会增加风险及成本。
  • 经颈静脉技术的侵入性大于经皮穿刺方法，但对出血素质或禁忌使用经皮穿刺技术的患者有用。

                             

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Literature review current through: 2017-06 . | This topic last updated: 2016-03-03.
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