Some people think that if the puncture is good, they can find out what the disease is at once and take fewer detours; Some people think that puncture is risky, after all, it is an invasive operation, and many complications will occur if it is not done well. (Invasive operation refers to all kinds of examination, diagnosis and treatment operations that are traumatic, dangerous and may have adverse consequences in the process of clinical diagnosis and treatment, such as cutting, puncture and peeling. )
Indeed, if you have a history of hepatitis or liver cirrhosis, the alpha-fetoprotein is obviously increased, and any imaging examination in enhanced CT/MRI/B ultrasound conforms to the characteristic imaging performance of "fast-in and fast-out", you can clinically diagnose liver cancer, and you don't need to make a definite diagnosis by puncture biopsy, but sometimes puncture biopsy has other uses. Whether it is necessary depends on everyone's specific situation. Today we will talk about some knowledge of liver biopsy.
Liver biopsy is a very mature operation. The patient only needs local anesthesia. Under the guidance of B-ultrasound or CT, they used a specific liver biopsy gun to puncture the liver or tumors on the liver through the skin, and then took liver tissue samples for pathological examination.
Generally speaking, liver biopsy is mainly used in the following three situations:
(1) for the diagnosis of unknown liver disease;
● Any unexplained abnormal liver function and hepatomegaly.
● It was found that the liver occupied a space and the nature of the tumor could not be determined.
● Whether there is rejection after liver transplantation.
(2) Used for staging of known liver diseases:
● Determine the activity and progress of chronic hepatitis, and determine the stages of liver fibrosis.
● Used to judge the degree of steatosis or rejection of donor liver in liver transplantation.
Judging the differentiation degree of liver malignant tumor is used for tumor staging.
(3) It can be used to make treatment plan, evaluate curative effect and judge prognosis.
For example, whether the inflammation of chronic hepatitis B patients has improved after antiviral treatment, and whether liver fibrosis has been reversed.
● Pathological examination of liver malignant tumor to judge the prognosis of patients or the risk of tumor recurrence.
● Detection of molecular subtypes of liver cancer and screening of potential beneficiaries of targeted therapy or immunotherapy.
In these cases, liver biopsy can be performed to obtain the "gold standard" of diagnosis and treatment through pathology.
Generally speaking, liver biopsy has the following three potential risks:
● Hemorrhage: Because the blood supply of the liver itself is abundant, blood vessels in the liver may be damaged during puncture, resulting in hematoma in the liver, biliary tract hemorrhage or intra-abdominal hemorrhage.
● If a malignant tumor is punctured, the tumor may spread and metastasize with the puncture needle, but the literature reports that this probability is very low.
● Local pain or secondary infection.
Generally speaking, the total incidence of serious complications after liver biopsy is less than 65438 0%. As long as the doctors and patients cooperate well, this is a very safe operation, but sometimes there is a risk that the ultrasound positioning is inaccurate or the patient's position changes, which leads to the puncture of the lesion.
In liver biopsy, if all operations are the same, there must be contraindications if there are indications, and the following four types of patients are not suitable for liver biopsy.
(1) Patients with poor coagulation status, such as hemophilia, have prolonged coagulation time and significantly decreased platelets; Or patients with abnormal coagulation caused by long-term oral anticoagulants.
(2) Patients who can't actively cooperate.
(3) The puncture tissue may be a patient with hemangioma or biliary tumor.
(4) Patients with massive ascites or liver failure.
In fact, liver puncture is not as terrible as imagined, especially today when accurate treatment of liver cancer is advocated.
The role of liver biopsy is not only limited to the diagnosis of liver cancer, but also can provide rich biological information for liver cancer, a highly heterogeneous tumor, which is convenient for doctors to identify subtle differences between different liver cancer patients and provide the best treatment plan and accurate prognosis evaluation for liver cancer patients.
Therefore, liver biopsy should be done: grasp the indications, don't be afraid when you need to do it, just do it!