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经颈静脉肝活组织检查

Authors
Jonathan B Kruskal, MD, PhD
Felipe B Collares, MD
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
路又可, 主任医师，教授

引言

尽管临床医学、生化分析以及诊断成像技术在不断发展和进步，对肝脏的组织学检查在肝病患者管理中仍有重要作用。经皮穿刺肝活组织检查已被证明是快速、安全和有效的方法，以至于该方法成为肝组织采样的金标准。

然而，经皮穿刺肝活组织检查需要穿过肝包膜，对于正在服用抗凝药或有凝血病的患者，其腹腔内出血的风险会增高(表 1)。病态肥胖和大量腹水等其他因素也使经皮入路的难度大增，并增加了操作相关风险。因此，为了对经皮穿刺操作有禁忌证的患者进行肝组织采样，已有人研发了替代技术，如经颈静脉肝活组织检查[1,2]。 (参见“经皮肝活检、细针抽吸肝活检和腹腔镜肝活检”)

本专题将总结经颈静脉肝活组织检查。经皮穿刺肝活组织检查、经颈静脉肝内门体分流术以及活检样本解读将单独讨论。 (参见“经皮肝活检、细针抽吸肝活检和腹腔镜肝活检”和“经颈静脉肝内门体静脉分流术：适应证与禁忌证”和“肝活检样本的解读”)

适应证与禁忌证

肝活组织检查可为急/慢性肝病患者的诊断、预后、疾病分期及治疗提供有用的信息(表 2)。活检的适应证包括：了解肝实质疾病的性质、对肝功能检查异常的评估、了解影像学检查异常的性质、药物治疗不良反应的检测和分期、移植术后肝脏状态的评估、急性肝衰竭的评估以及不明原因发热的评估。

与经皮穿刺活检不同，经静脉入路通过上腔静脉和肝静脉进入肝实质并获得肝组织，而无需穿过肝包膜。活检部位如果出血，则会定向流入穿刺静脉，将腹腔内出血的风险减到最小。

     

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Literature review current through: 2017-06 . | This topic last updated: 2015-12-17.
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