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采用19G细针穿刺活检针对为排除胆道梗阻而接受超声內镜检查的患者行同期超声内镜引导下肝活检的高产率

发布日期:2014-1-29 12:40:26 文章来源:GIE 作者次数:1218
    采用19G细针穿刺活检针对为排除胆道梗阻而接受超声內镜检查的患者行同期超声内镜引导下肝活检的高产率

    背景

    內镜超声(EUS)引导下Trucut肝活检所得标本充足性可变且成本较高,这限制了它的应用。一种能够保证标本充足的改良超声內镜(EUS)引导技术可能是一种可行的标准技术的替代方式,而且其临床成本比较经济。

    目的

    描述我们在成本较低的环境中采用19G细针穿刺活检所用且无切割的针行超声內镜(EUS)引导的肝活检的经验:病因不清的肝功能异常患者可以采用EUS来排除胆道阻梗,如果EUS显示为阴性则有关医师可进行下一步的肝活检。

    设计

    前瞻性病例系列。

    环境

    三级护理教学医院

    患者

    肝功测试结果异常患者行EUS

    干预

    采用19G细针穿刺针(无切割)行EUS引导下肝活检

    主要测量指标

    诊断率,样本充足性,并发症。长度为15毫米或更长且完整的汇管区CPTs)有6个或更多的这样一个标本才是恰当的。

    结果

    20087月至20117月,31例连续病例中22例满足纳入标准,并接受了超声內镜检查(EUS)而且检查结果显示为阴性,同时他们也接受了同期采用19G细针穿刺活检针的超声內镜引导下肝活检。中位数为2的细针穿刺活检次数(范围:1-3)取得长度中位数为36.9mm(范围:2-184.6mm)的标本与中位数为91-73)的CPTs。超声內镜引导下肝活检从22例患者中的2091%)提供了一次组织学诊断机会与充足的标本。正是由于丰富的经验而使所获得的标本充足性有所改善。试验中为发现并发症。

    局限性

    研究规模小。

    结论

    采用19G细针穿刺针行超声內镜引导下的肝活检似乎是可行且安全的,同时它具有较高诊断率和良好的标本充足性。

    缩写词:CPT,完整的汇管区;EUS-FNA超声內镜引导下细针穿刺活检;INR,国际标准化比值。

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     High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction

    Background

    EUS-guided liver biopsy by Trucut yields variable specimen adequacy at high cost, limiting its utility. A modified EUS-guided technique with reliable adequacy could be a viable alternative to standard techniques in cost-effective clinical settings.

    Objective

    To describe our experience with EUS-guided liver biopsy by 19-gauge FNA, non-Trucut, needle in a cost-effective setting: patients with abnormal liver test results of unclear etiology referred for EUS to exclude biliary obstruction in whom an unrevealing EUS would have prompted a next-step liver biopsy by the referring physician.

    Design

    Prospective case series.

    Setting

    Tertiary-care teaching hospital.

    Patients

    Consecutive patients with abnormal liver tests referred for EUS.

    Interventions

    EUS-guided liver biopsy by 19-gauge FNA needle (non-Trucut).

    Main Outcome Measurements

    Diagnostic yield, specimen adequacy, and complications. An adequate specimen was defined as a length of 15 mmor longer and 6 or more complete portal tracts (CPTs).

    Results

    Between July 2008 and July 2011, 22 of 31 consecutive patients meeting inclusion criteria underwent unrevealing EUS with same-session EUS-guided liver biopsy by 19-gauge FNA needle. A median of 2 FNA passes (range 1-3) yielded a median specimen length of36.9 mm(range 2-184.6 mm) with a median of 9 CPTs (range 1-73 CPTs). EUS-guided liver biopsies yielded a histologic diagnosis and adequate specimens in 20 of 22 patients (91%). Expanded experience led to improved specimen adequacy. There were no complications.

    Limitation

    Small study size.

    Conclusions

    EUS-guided liver biopsy by using a 19-gauge FNA needle appears to be feasible and safe and provides excellent diagnostic yield and specimen adequacy.

    Abbreviations:  CPT, complete portal tract, EUS-FNA, EUS-guided FNA, INR, international normalized ratio

     

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