4200例肝穿刺活检组织病理与临床分析

目的分析肝穿刺活检组织病理与临床诊断结果，评价各型病毒性肝炎及其他类型肝病临床与病理诊断符合率。方法采用1秒钟快速肝穿刺活检术，肝内局灶占位病变则在彩超引导下行病变处穿刺活检，肝组织常规做HE染色、Masson及网状纤维染色，根据临床病情需要加做免疫组织化学及特殊染色如刚果红、PAS、红氨酸染色等。结果病毒性肝炎临床与病理诊断分级的总体符合率约66．2％，其中以慢性肝炎轻度符合率最高，达81．3％，而急性肝炎的符合率最低，为38％；脂肪性肝炎临床与病理诊断符合率为70．6％；肝脏肿瘤及瘤样病变临床与病理诊断符合率达92．3％；遗传与代谢性疾病临床与病理诊断符合率为70．8％。结论病毒性肝炎临床与病理诊断一致性还存在一定的差异，临床资料对病理诊断有重大帮助；肝穿刺活检术是诊断脂肪肝的重要方法之一；肝穿刺术对各类原发及转移性肝脏肿瘤鉴别诊断意义最大，在罕见及疑难肝脏疾病诊断中具有辅助确诊作用。

Clinical and pathological analysis of 4200 liver biopsies

Objective To improve the clinical level of hepatopathy, diagnose accordance rate of different types of viral hepatitis and other liver diseases was assessed through the analysis of the result from liver biopsy. Methods The color ultrasound guided liver fine needle aspiration biopsy was performed in focal liver lesions cases,and others were obrained by Menghini technique using a 16 G Braun needle. They were stained with Heamatoxylin-Eosine, Masson＇s richrome and reticular fiber staining. And varied from different pathogenetic condition clinically, immunohistochemistry experiment and special stain like Congo red, PAS, immunohistochemistry etc. were adopted when needed. Results 66.2% of the total diagnosis accordance rate of grading of the clinicopathologic diagnosis for viral hepatitis was obtained, of which the chronic hepatitis ranked the highest with 81.3%, and the lowest is from acute hepatitis with 38%, 70.6% for fatty liver disease, 92.3% for liver tumor or tumor-like conditions, and 70.8% for hereditary and metabolic liver diseases. Conclusion The clinical profile is important to the pathologic diagnosis for the difference of consistency of clinical diagnosis and pathologic diagnosis. The liver biopsy contributed the greatest to differential diagnosis of all category of primary and metastatic liver tumour. And this study shows the importance of liver biopsy in determining rare liver disease.