Chronic liver diseases, such as chronic hepatitis, liver cirrhosis and so on are common diseases that endanger human beings. The course of this kind of disease is long and will seriously affect the work and life of patients. If it is not well controlled, it may become liver failure, liver cancer and other serious consequences. Therefore, early diagnosis, long-term treatment and regular reexamination are all very important for these liver disease patients.
How much do you know about liver disease examination
There are many methods for liver disease examination, which can be divided into two categories according to whether there will be trauma:
- The first type is non-invasive examination, such as the well-known liver function, hepatitis B two-and-a-half, B-ultrasound, CT, nuclear magnetic resonance (MRI), etc. The second type is invasive examination represented by liver biopsy, i.e. Liver puncture biopsy. A small part of the liver is taken and observed under a microscope.
Although molecular biology and imaging medicine technologies are changing with each passing day, the diagnosis that can be made through a drop of blood and a frame of pictures is becoming more and more accurate. However, since these methods are all indirect examinations, they are not as direct as the direct observation of the diseased liver under the microscope (the difference between [rather critical] and [little knowledge]). Therefore, liver biopsy is still the irreplaceable [gold standard] in the diagnosis of liver diseases.
At present, the commonly used clinical liver biopsy techniques include: fine needle biopsy, transjugular intrahepatic biopsy and wedge resection biopsy, with different trauma sizes and applicable situations. This article only briefly introduces fine needle biopsy.
Since 1958, when German doctor Menghini first reported [percutaneous fine needle liver biopsy], Because of its convenience, safety, Quickly popularized, It has become the most commonly used liver biopsy technique. The so-called “percutaneous” refers to the puncture needle penetrating the skin and entering the liver. The “fine needle” refers to the liver puncture needle. This is a hollow needle with a diameter of about 1 ~ 2 mm. The needle is equipped with a device to control the puncture depth. When the puncture needle enters the liver, under the action of cutting and aspiration, a certain amount of liver tissue will be filled into the needle core as our test sample.
As a invasive examination, Liver biopsy is actually a small operation: With the cooperation of imaging doctors and clinicians, a safe (avoiding major blood vessels) and fast puncture route is determined through B-ultrasound or CT. After disinfection and local anesthesia, the needle is gradually inserted under the guidance of B-ultrasound or CT until specimens are obtained. After puncture, patients usually need to lie down and rest for about 24 hours, and blood pressure and heart rate are monitored at the same time to avoid complications such as puncture site hemorrhage.
Which situations require liver biopsy?
Generally speaking, the role of clinical examination can be summarized into two categories: diagnosis and evaluation. The same is true for liver biopsy:
1. Liver diseases that need to be diagnosed: For example, different types of acute and chronic hepatitis, there is a lump that does not know whether it is benign or malignant, and liver function abnormality cannot find out the cause, etc. In these cases, non-invasive examination is difficult to make a clear diagnosis, only the killer is offered and confirmed by liver puncture biopsy.
2. For the evaluation of disease progression or therapeutic effect, such as the evaluation after anti-hepatitis virus treatment, the evaluation of liver fibrosis degree, the evaluation of transplanted liver status, etc., repeated liver biopsy is required to dynamically observe disease changes.
What are the possible risks of liver puncture?
Generally speaking, liver biopsy is still a relatively safe examination. Especially with the development of technology, liver biopsy guided by B-ultrasound or CT has fewer complications and a short duration. Possible problems mainly include pain, hemorrhage, hemopneumothorax, peritonitis, etc.
Among them, the most serious complication is hemorrhage, which usually occurs within 3 days after operation. The elderly, liver biopsy for more than 3 consecutive times and patients with liver cirrhosis are more likely to suffer from hemorrhage. Once hemorrhage occurs after operation, B-ultrasound examination should be used regularly to monitor the hemorrhage. Patients should stay in bed, usually, a small amount of bleeding can be stopped by themselves without treatment. However, if a large hemorrhage occurs, the patient may show accelerated heart rate, hypotension, pale skin and mucous membrane, cold sweat, etc., then immediate blood transfusion or hemostasis treatment is required.
In addition, if it is suspected to be liver cancer before puncture, due to the destruction of the integrity of the tumor capsule, it may lead to the spread and metastasis of the tumor along the puncture channel. Therefore, doctors and family members are required to discuss and evaluate at this time, and the risk of examination and delay in diagnosis and treatment is more important.
What conditions cannot be performed for liver biopsy?
Since the patient needs to hold his breath when fine needle puncture enters the liver, if the patient cannot cooperate with the doctor, then this examination cannot be done. In addition, if it is highly suspected to be hemangioma, it is also better not to do puncture to avoid rupture and hemorrhage. Check the coagulation function before puncture. If there is any problem, it is better not to do it either. In addition, a large number of patients with ascites, liver echinococcosis and obesity are not suitable for liver biopsy.
Why do you need to wear it several times sometimes?
There are usually the following possibilities, which need to be worn several times:
First of all, as a medical examination method, The accuracy rate of liver biopsy is not 100% ([100% × ×] examination method will only exist in the propaganda slogans of some irresponsible medical institutions). Due to cognitive limitations, even if doctors do their best, it is still difficult to diagnose many difficult and complicated diseases. Otherwise, there is still room for improvement in medicine.
Secondly, it may be that the specimen worn out for the first time is unqualified, In order to improve the accuracy of diagnosis, There are certain standards for liver puncture specimens. Generally, liver puncture biopsy specimens are required to be 1-3 cm long and 1.2-2 mm in diameter. A specimen contains at least 6-8 portal areas (a microstructure of the liver). Therefore, not every liver puncture specimen meets the standard, and sometimes repeated puncture examinations are required to obtain satisfactory specimens.
Thirdly, it may be determined by the nature of liver lesions. For the diseases that the whole liver will suffer from, such as viral hepatitis, primary sclerosing cholangitis, hemochromatosis, etc., any one point is sufficient to reflect the whole picture of liver lesions. However, for diseases such as liver cirrhosis, the specimen is easily fragmented during the sampling process, and the specimen may contain too much fibrous tissue and insufficient number of liver lobules. Pathological examination results of focal lesions such as inflammatory hyperplasia and liver tumors are related to the sampling site.
Therefore, in case of these situations, repeated puncture may be required.
Summary
In a word, liver biopsy, as the “gold standard”, is widely used in the diagnosis of liver diseases. As long as it is carried out in accordance with medical standards, the operation of liver biopsy is generally very safe, because of the limitation of current technology, this examination still has certain limitations, but with the progress of medicine, liver biopsy will definitely be safer, faster and more accurate.