超声引导下儿童移植肝穿刺活检的临床分析

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。

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

ObjectiveTo evaluate the effectiveness and safety of ultrasound-guided transplanted liver biopsy in children. MethodsWe 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. ResultsA 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). ConclusionUltrasound-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.