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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2022, Vol. 19 ›› Issue (01) : 31 -36. doi: 10.3877/cma.j.issn.1672-6448.2022.01.006

介入超声影像学

超声引导下儿童移植肝穿刺活检的临床分析
井好雨1, 钱林学1,†(), 何恩辉1, 徐瑞芳1, 史宪全1, 易展雄1, 李丽1, 孙丽莹1, 刘颖1, 张梁1   
  1. 1. 100050　首都医科大学附属北京友谊医院超声医学科
  • 收稿日期:2021-02-02 出版日期:2022-01-01
  • 通信作者: 钱林学
  • 基金资助:
    首都卫生发展科研专项项目(2020-4-20211)

Clinical efficacy and safety of ultrasound-guided transplanted liver biopsy in children

Haoyu Jing1, Linxue Qian1,†(), Enhui He1, Ruifang Xu1, Xianquan Shi1, Zhanxiong Yi1, Li Li1, Liying Sun1, Ying Liu1, Liang Zhang1   

  1. 1. Department of Ultrasonography, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
  • Received:2021-02-02 Published:2022-01-01
  • Corresponding author: Linxue Qian
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井好雨, 钱林学, 何恩辉, 徐瑞芳, 史宪全, 易展雄, 李丽, 孙丽莹, 刘颖, 张梁. 超声引导下儿童移植肝穿刺活检的临床分析[J]. 中华医学超声杂志（电子版）, 2022, 19(01): 31-36.

Haoyu Jing, Linxue Qian, Enhui He, Ruifang Xu, Xianquan Shi, Zhanxiong Yi, Li Li, Liying Sun, Ying Liu, Liang Zhang. Clinical efficacy and safety of ultrasound-guided transplanted liver biopsy in children[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(01): 31-36.

目的

评价超声引导下儿童移植肝穿刺活检的有效性和安全性。

方法

回顾性分析2018年1月至2020年12月于首都医科大学附属北京友谊医院行超声引导下移植肝穿刺活检术患儿的临床病史、实验室检查、穿刺记录、术后并发症及病理结果。采用χ2检验/Mann-Whitney U检验比较并发症组与无并发症组患儿年龄、性别、穿刺次数、血小板、凝血酶原活动度等实验室检查指标的差异。

结果

共进行了180例次移植肝穿刺活检术，获取184份肝穿刺活检标本，其中176份移植肝穿刺活检，4例次移植肝和自体肝穿刺活检。所有患儿均成功穿刺，病理取材成功率为95.7%（176/184），穿刺后未发生严重并发症，轻微并发症发生率为8.9%（16/180）。对比并发症组患儿（16例次）与无并发症组患儿（164例次）的基本情况、穿刺次数、实验室检查，发现并发症组患儿年龄更低［3.0（0.9，15.0）岁 vs 5.0（0.40，16.0）岁］，肝功能更差［天门冬氨酸氨基转移酶：62.8（22.70，659.00）U/L vs 40.60（12.70，446.20）U/L；总胆红素：9.74（3.59，43.46）μmol/L vs 9.45（2.42，751.00）μmol/L］，血小板计数更低［213.00（58.00，337.00）×109/L vs 233.00（46.00，490.00）×109/L］以及凝血酶原活动度更低［82.30（58.00，103.00）% vs 85.00（58.00，132.10）%］，差异均具有统计学意义（Z=-2.892、-3.211、-2.007、-3.960、-2.906，P=0.004、=0.001、=0.045、＜0.001、=0.004）；性别及每例次穿刺次数差异均无统计学意义（P均＜0.05）。

结论

超声引导下儿童移植肝穿刺活检可靠、安全，具有较高的诊断率和低并发症发生率。低龄、肝功能差、血小板计数低、凝血酶原活动度低是儿童移植肝穿刺活检出血的危险因素。

关键词: 超声, 儿童, 移植肝, 穿刺活检, 危险因素
Objective

To evaluate the effectiveness and safety of ultrasound-guided transplanted liver biopsy in children.

Methods

We conducted a retrospective analysis of all children who underwent ultrasound-guided transplanted liver biopsy at Beijing Friendship Hospital Affiliated to Capital Medical University between January 2018 and December 2020. Clinical history, laboratory findings, biopsy records, complications, and pathological outcomes were recorded. The χ2 test/Mann-Whitney U test was used to compare the differences in age, sex, the number of needle passes, and values of laboratory examination (including platelets, prothrombin activity, etc.) among the children with complications and those without to figure out the statistically significant factors between the two groups.

Results

A total of 180 biopsies were obtained, including 176 biopsies of transplanted liver and 4 biopsies of both transplanted liver and native liver. All the children were successfully punctured, and the diagnostic yield was 95.7% (176/184). No major complications occurred, and the rate of minor complications was 8.9% (16/180). A comparative analysis was performed between children with complications (16 biopsies) and those without (164 biopsies) in terms of the basic conditions, the number of needle passes, and laboratory findings. It was found that children with complications were younger [3.0 (0.9, 15.0) years old vs 5.0 (0.40, 16.0) years old, Z=-2.892, P=0.004], and had worse liver function [aspertate aminotransferase: 62.8 (22.70, 659.00) U/L vs 40.60 (12.70, 446.20) U/L, Z=-3.211, P=0.001; total bilirubin: 9.74 (3.59, 43.46) μmol/L vs 9.45 (2.42, 751.00) μmol/L, Z=-2.007, P=0.045], lower platelet count [213.00 (58.00, 337.00)×109/L vs 233.00 (46.00, 490.00)×109/L, Z=-3.960, P＜0.001], and lower prothrombin activity [82.30 (58.00, 103.00)% vs 85.00 (58.00, 132.10)%, Z=-2.906, P=0.004]. However, sex and the number of needle passes did not affect the occurrence of complications (P＞0.05 for both).

Conclusion

Ultrasound-guided liver biopsy is a reliable and safe method with a high diagnostic yield and low complication rate. Younger age, poor liver function, and lower platelet count and prothrombin activity are risk factors for post-biopsy bleeding in children.

Key words: Ultrasound, Children, Transplanted liver, Biopsy, Risk factor
图1 实时超声引导下儿童移植肝组织穿刺活检
图2 实时超声引导下儿童移植肝占位性病变穿刺活检
图3 儿童移植肝穿刺标本病理图（HE×100）
图4 彩色多普勒超声示儿童移植肝穿刺沿穿刺针针道的彩色血流信号
表1 2组移植肝穿刺患儿性别、年龄、穿刺次数及实验室检查之间的比较
项目 并发症组（n=16例次） 无并发症组（n=164例次） 统计值 P值
年龄［岁，M（QR）］ 3.0（0.9，15.0） 5.0（0.40，16.0） Z=-2.892 0.004
性别 χ2=0.035 0.852

男

 8 86

女

 8 78
每例次穿刺次数 χ2=0.001 0.970

1次

 11 112

2次

 5 52
ALT［U/L，M（QR）］ 64.00（11.00，801.00） 29.00（4.00，797.00） Z=-1.067 0.286
AST［U/L，M（QR）］ 62.80（22.70，659.00） 40.60（12.70，446.20） Z=-3.211 0.001
TBIL［μmol/L，M（QR）］ 9.74（3.59，43.46） 9.45（2.42，751.00） Z=-2.007 0.045
PLT［×109/L，M（QR）］ 213.00（58.00，337.00） 233.00（46.00，490.00） Z=-3.960 ＜0.001
PT［s，M（QR）］ 12.20（10.60，15.40） 12.00（10.10，15.40） Z=-1.336 0.182
PTA［%，M（QR）］ 82.30（58.00，103.00） 85.00（58.00，132.10） Z=-2.906 0.004
INR［M（QR）］ 1.13（0.98，1.41） 1.10（0.90，1.42） Z=-1.867 0.062
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