liver biopsy

Liver puncture is a simple method to take liver tissue specimens. There are various puncture methods, such as general liver puncture, trocar puncture, lobectomy, and rapid liver puncture. The first three types are more likely to cause liver damage or bleeding; the latter is safer, and this method is often used clinically. Liver pathological anatomy and pathophysiology are the basis of modern hepatology, so histopathological observation and research on dirty diseases are important for understanding its etiology, mechanism, determining diagnosis, determining treatment and evaluating efficacy. Treatment of diseases: liver cancer liver abscess Indication Due to the development of laboratory and imaging diagnostic techniques, most patients who have been diagnosed with liver biopsy in the past can be diagnosed and diseased by serological, immunological, molecular biology and imaging studies, and are not forced to undergo biopsy, such as: Acute hepatitis, acute jaundice, hepatocellular carcinoma, and benign tumors of the liver (such as hemangioma). There are also some new indications such as liver transplantation, liver complications of kidney transplantation, and new drug-induced liver injury. The indications for liver biopsy can be summarized as follows: 1. Assessment of staging and grading of chronic hepatitis; 2. Diagnosis of abnormal liver function test with unknown cause; 3. Diagnosis and staging of alcoholic liver disease; 4. Liver granuloma and systemic inflammation; 5. Determination of drug-induced or industrially toxic liver disease, evaluating hepatotoxicity of drugs for treatment of non-hepatic diseases; 6, cirrhosis; 7. Intrahepatic cholestasis; 8. Diagnosis of multiple system invasive diseases; 9, intrahepatic space-occupying lesions; 10. Unexplained liver and splenomegaly, and clinical diagnosis of unexplained hepatomegaly is difficult. Such as various types of viral hepatitis, alcoholic hepatitis, liver tuberculosis, hepatic granuloma (tuberculosis, brucellosis, histoplasmosis, syphilis, etc.), schistosomiasis, liver tumor, fatty liver, liver abscess, primary Biliary cirrhosis and various metabolic liver diseases (hepatolenticular degeneration, hepatic glycogen accumulation disease, liver amyloidosis), etc., often require liver puncture to understand the patient's liver disease, providing important and even possible diagnosis Is the decisive basis; 11. Liver condition after liver transplantation; 12. Liver complications after kidney transplantation; 13. Unexplained fever, liver tissue culture or other pathogenic examinations; 14. Evaluate the efficacy and safety of medications. Contraindications Liver puncture is extremely valuable for judging the development of hepatitis disease. It is the gold standard for pathological staging, but not everyone is suitable for liver puncture. The following are the objects that cannot or need to be carefully selected for this check method. 1. Patients who cannot cooperate or coma; 2. Patients with bleeding tendency. Such as hemophilia, hepatic cavernous vascular disease, prolonged clotting time, thrombocytopenia up to 80 × 109 / liter, prothrombin activity (PTA) is less than 50%; 3. A large amount of ascites or severe jaundice; 4. Severe anemia or poor general condition; 5. Severe extrahepatic obstructive jaundice with gallbladder enlargement; 6. Right empyema, underarm abscess, pleural effusion or suspected hepatic echinococcosis or hepatic hemangioma, local infection at the puncture site; 7. The liver is shrinking or the liver is dull; 8. Severe heart, lung, kidney disease or its functional failure; Preoperative preparation 1. 3 days before puncture, daily injection or oral vitamin K, calcium and vitamin C. 2. The patient's platelet count, clotting time, prothrombin time were measured 1 day before puncture, and blood was prepared if necessary. 3. 0.03 g of codeine and sodium phenobarbital were given 1 hour before surgery. 4. Blood pressure, pulse, etc. are measured before puncture. Surgical procedure 1. Explain to the patient the purpose, significance and precautions of the puncture, and eliminate the tension to obtain the cooperation of the patient. 2. Carry the object to the bedside, cover the patient with a screen, and assist the patient to empty the bladder. 3. The patient takes the supine position, leans slightly to the left, the right side of the body is close to the edge of the bed, a pillow is placed under the right rib of the back, and the right arm is bent behind the head. Take a sitting position or a semi-recumbent position when pus is taken. 4. Puncture site: generally puncture the ninth and tenth intercostal space of the eighth, nine intercostal or midline of the anterior line. If the hepatomegaly is more than 5 cm below the costal margin, it can also be puncture from the costal margin. 5. Place the abdomen, blanket, and treatment towel on the patient's back. Assist doctors to routinely disinfect skin, place sterile hole towels, and perform local infiltration anesthesia. 6. The surgeon uses a rubber tube to connect the 20ml syringe and the liver puncture needle to check whether the parts are tightly connected. When there is no air leak, suck the sterile saline 3-5ml and drain the gas in the syringe. First puncture the skin with a puncture cone. The needle is inserted into the upper edge of the rib by 0.5-1 cm. The nurse injects 0.5-1 ml of saline into the syringe to flush out the skin and subcutaneous tissue that may remain in the needle cavity of the liver to avoid clogging of the needle. 7. Aspirate the needle to the 5-6 ml mark of the syringe to create and maintain a negative pressure inside the needle until the end of the procedure. Then the patient was inhaled deeply and breathed for a while. At the beginning of the patient's breath holding, the puncture needle is perpendicular to the skin, quickly penetrates into the liver tissue, and is immediately pulled out. This action is generally completed in about 1 second. Absolutely can not stir the puncture needle, the penetration depth is generally about 4-6cm. 8. Pull out the liver and put it with a sterile gauze. Press the puncture site for a few minutes, fix it with a tape, press the sand bag to pressurize it, fasten the abdomen, and inject the obtained liver tissue into the specimen bottle. 9. After the puncture is completed, the patient is placed, the used materials are cleaned, and the specimen is immediately sent for inspection. complication 1, bleeding; 2, biliary peritonitis; 3, sepsis; 4, bacteremia; 5, local pain; 6, transient hypotension or pleural shock.

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