【摘要】 目的 探讨经皮肝穿刺活检的安全性及应用价值。方法 收集2014年1月至2023年6月在上海中医药大学附属曙光医院肝硬化科行经皮肝穿刺活检术的患者临床资料，包括患者性别、年龄、血常规、凝血功能、肝肾功能、肝脏弹性超声、临床诊断、病理诊断。对经皮肝穿刺活检术的适应证、并发症及处理、诊断价值进行分析。结果 共727例经皮肝穿刺活检患者，6例患者分别因右肝萎缩(3例)、过度肥胖(2例)和先天镜像异位(1例)而采用肝左叶穿刺，其余均采用肝右叶穿刺进针。共有5例患者出现穿刺后出血并发症(4例腹腔，1例胸腔),其INR<1.5,血小板计数>50×10~9/L;14例血小板计数<50×10~9/L的患者未出现出血并发症。从诊断分布上看，有超过50%的伴或不伴肝硬化的慢性乙型肝炎病例；有200例(27.5%)存在穿刺前临床诊断与病理诊断的差异，除了肝硬化程度判断差异之外，还包括病因诊断的不一致，集中于原发性胆汁性胆管炎、自身免疫性肝炎、药物性肝损伤、非酒精性脂肪性肝炎及重叠综合征等。结论 经皮肝穿刺活检多用于不明原因肝损伤与肝硬化病因诊断、自身免疫性肝病的鉴别诊断、肝纤维化程度及疗效评价；血小板<50×10~9/L并非穿刺后出血等并发症发生的主要原因，但需经充分评估后谨慎穿刺。更多还原

【Abstract】 Objective To investigate the safety and application value of percutaneous liver biopsy. Methods A retrospective analysis was conducted on the clinical data of patients who underwent percutaneous liver biopsy in the Liver Cirrhosis Department of Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine from January 2014 to June 2023. The data included patient demographics(sex, age), blood routine tests, coagulation function, biochemical indicators of liver and kidney function, liver stiffness measurement, clinical diagnosis, and pathological diagnosis. The indications, complications and their management, and diagnostic value of percutaneous liver biopsy were analyzed and evaluated. Results Among the 727 patients who underwent percutaneous liver biopsy, aged between 19 and 86 years, liver biopsy was performed on the left lobe in 6 patients due to right liver atrophy(3 cases), excessive obesity(2 cases), and situs inversus(1 case), while the remaining patients underwent biopsy on the right lobe. 5 patients experienced post-biopsy hemorrhage complications(4 in the abdominal cavity and 1 in the pleural cavity), all of them with an INR less than 1.5 and platelet counts above 50×10~9/L; no hemorrhage complications occurred in the 14 cases with platelet counts below 50×10~9/L. In terms of diagnostic distribution, over 50% of the cases involved chronic hepatitis B, either with or without cirrhosis, primarily used in clinical trials to evaluate the efficacy of treatments for hepatitis B-related liver fibrosis. There were 200 patients(27.5%) who exhibited discrepancies between pre-biopsy clinical diagnosis and pathological diagnosis. Beyond differences in the assessment of cirrhosis severity, these discrepancies also included inconsistent etiological diagnoses, particularly in differentiating primary biliary cholangitis, autoimmune hepatitis, drug-induced liver injury, non-alcoholic steatohepatitis, and overlap syndromes. Conclusion Percutaneous liver biopsy is frequently used in diagnosing the etiology of unexplained liver injury and cirrhosis, differentiating autoimmune liver diseases, and assessing the severity of liver fibrosis and treatment efficacy. A platelet count below 50×10~9/L is not the primary cause of post-biopsy complications such as hemorrhage, but caution should be exercised and a thorough assessment should be conducted before performing the biopsy.更多还原