Эффективность и безопасность эндохирургической биопсии у детей с хроническими болезнями печени
________________________________________________
Khrolenko P.V., Yatsyk S.P., D'yakonova E.Yu. et al. Efficacy and safety of endosurgical biopsy in children with chronic liver disease. Pediatrics. Consilium Medicum. 2020; 1: 77–81. DOI: 10.26442/26586630.2020.1.200050
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Материалы и методы. В проведенное одноцентровое двунаправленное (ретро- и проспективное) исследование были включены 175 пациентов с ХБП: 75 детям, составившим основную группу, биопсию печени проводили методом краевой резекции, и 100 пациентам с ХБП, включенным в группу сравнения, ранее была выполнена пункционная биопсия. Проводили сравнительный анализ длительности выполнения биопсии, наличия и характера осложнений, количества содержащихся портальных трактов в полученных образцах, числа фрагментированных и неинформативных биоптатов при поведении пункционной биопсии и краевой резекции ткани печени под лапароскопическим контролем.
Результаты. Проведение краевой резекции гепатобиоптата занимало в среднем 21,7 мин. Осложнений не отмечалось. Проведение пункционной биопсии занимало в среднем 19,4 мин. В 4 случаях отмечалось развитие осложнений (2 случая кровотечения из места пункции, однократно – нарушение целостности стенки желчного пузыря с развитием локального билиарного перитонита, развитие пневмоторакса вследствие повреждения легкого). Согласно критерию Манна–Уитни выявлены статистически достоверные различия количества портальных трактов в основной и группе сравнения (p=0,000). Количество портальных трактов при проведении краевой резекции гепатобиоптата составило в среднем 93, при проведении пункции – 5. Информативность биоптатов в основной группе составила 100%. Фрагментации биопсийного материала не отмечалось. В группе сравнения информативность биоптатов составила 86%, 20% биоптатов оказались фрагментированными.
Ключевые слова: хронические болезни печени, биопсия печени, дети.
________________________________________________
Background. A variety of pathomorphological manifestations of chronic liver diseases (CLD) in children necessitates a sufficient size for a reliable morphological assessment of the size of the hepatobioptate. Marked fibrotic changes in liver tissue and the presence of a high incidence of hemostatic disorders increase the risk of complications during a biopsy. In view of this, the liver biopsy method should be selected in accordance with the amount of biopsy material necessary for an accurate verification of the diagnosis, being the most effective and at the same time the safest with respect to the risks of complications both during the biopsy and in the postoperative period.
Materials and methods. The one-center bi-directional (retro- and prospective) study included 175 patients with CLD: 75 children who made up the main group had a liver biopsy by edge resection, and 100 patients with CLD included in the comparison group had previously undergone a biopsy. A comparative analysis of the duration of the biopsy, the presence and nature of the complications, the number of portal tracts contained in the obtained samples, the number of fragmented and uninformative biopsy samples during the behavior of the puncture biopsy and marginal resection of the liver tissue under laparoscopic control was performed.
Results. Hepatobioptate marginal resection took an average time of 21.7 minutes. No complications were noted. A puncture biopsy took an average of 19.4 minutes. In four cases, the development of complications was noted (two cases being the bleeding from the puncture site, one case being a violation of the integrity of the gallbladder wall with the development of local biliary peritonitis, the development of pneumothorax due to lung damage). According to the Mann – Whitney criterion, statistically significant differences in the number of portal tracts in the main and comparison groups were revealed (p=0.000). The number of portal tracts during the regional resection of the hepatobioptate averaged 93, while those happened during the puncture averaged 5. The information content of the biopsy samples in the main group was 100%. Fragmentation of biopsy material was not noted. In the comparison group, the informative value of biopsy samples was 86%, 20% of biopsy samples were fragmented.
Key words: chronic liver disease, liver biopsy, children.
2. Sheriff S, Cammel G, Carey WD et al. The role of liver biopsy in chronic hepatitis C. Hepatology 2001; 33 (1): 196–200. DOI: 10.1053/jhep.2001.20534
3. Imamura H, Kawasaki S, Bandai Y et al. Comparison between wedge and needle biopsies for evaluating the degree of cirrhosis. J Hepatol 1993; 17 (2): 215–9. DOI: 10.1016/S0168-8278(05)80041-8
4. Kalambokis G, Manousou P, Vibhakorn S et al. Transjugular liver biopsy – indications, adequacy, quality of specimens, and complications – a systematic review. J Hepatol 2007; 47 (2): 284–94. DOI: 10.1016/j.jhep.2007.05.001
5. Nousbaum JB, Cadranel JF, Bonnemaison G et al. [Clinical practice guidelines on the use of liver biopsy. (In French).] Gastroenterol Clin Biol 2002; 26 (10): 848–78.
6. Ovchinsky N, Moreira RK, Lefkowitch JH, Lavine JE. Liver biopsy in modern clinical practice: a pediatric point-of-view. Adv Anat Pathol 2012; 19 (4): 250–62. DOI: 10.1097/PAP.0b013e31825c6a20
7. Волынец Г.В., Потапов А.С., Полякова С.И. и др. Определение степени нарушения функции печени у детей. Вопросы современной педиатрии. 2013; 12 (4): 47–51. PMID: 26281158
[Volynets G.V., Potapov A.S., Poliakova S.I. et al. Opredelenie stepeni narusheniia funktsii pecheni u detei. Voprosy sovremennoi pediatrii. 2013; 12 (4): 47–51. PMID: 26281158 (in Russian).]
8. Маев И.В., Чарный А.М., Вьючнова Е.С. и др. Биопсия печени. Учебно-методическое пособие. М.: Издательство ИТРК, 2002.
[Mayev I.V., Charny A.M., Vyuchnova E.S. et al. Liver biopsy. Teaching aid. Moscow: Publishing house ITRK, 2002 (in Russian).]
9. Pokorska-Śpiewak M, Kowalik-Mikołajewska B, Aniszewska M et al. Is liver biopsy still needed in children with chronic viral hepatitis? World J Gastroenterol 2015; 21 (42): 12141–9. DOI: 10.3748/wjg.v21.i42.12141
10. Пинцани М. Эволюция фиброза печени: от гепатита к циррозу. Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2002; 12 (5): 4.
[Pintsani M. Evoliutsiia fibroza pecheni: ot gepatita k tsirrozu. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2002; 12 (5): 4 (in Russian).]
11. Gagner M, Rogula T, Selzer D. Laparoscopic liver resection: benefits and controversies. Surgl Clin North Am 2004; 84 (2): 451–62. DOI: 10.1016/j.suc.2003.11.002
12. Moy L, Levine J. Autoimmune Hepatitis: A Classic Autoimmune Liver Disease. Cur Probl Ped Adolescent Health Care 2014; 44 (11): 341–6. DOI: 10.1016/J.Cppeds.2014.10.005
13. Александрова Е.А., Бурневич Э.З., Арион Е.А. Системные проявления первичного склерозирующего холангита. Клиническая медицина. 2013; 4: 38–42.
[Aleksandrova E.A., Burnevich E.Z., Arion E.A. Sistemnye proiavleniia pervichnogo skleroziruiushchego kholangita. Klinicheskaia meditsina. 2013; 4: 38–42 (in Russian).]
________________________________________________
1. Colloredo G, Guido M, Sonzogni A, Leanardo G. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder disease. J Hepatol 2003; 39 (2): 239–44. DOI: 10.1016/s0168-8278(03)00191-0
2. Sheriff S, Cammel G, Carey WD et al. The role of liver biopsy in chronic hepatitis C. Hepatology 2001; 33 (1): 196–200. DOI: 10.1053/jhep.2001.20534
3. Imamura H, Kawasaki S, Bandai Y et al. Comparison between wedge and needle biopsies for evaluating the degree of cirrhosis. J Hepatol 1993; 17 (2): 215–9. DOI: 10.1016/S0168-8278(05)80041-8
4. Kalambokis G, Manousou P, Vibhakorn S et al. Transjugular liver biopsy – indications, adequacy, quality of specimens, and complications – a systematic review. J Hepatol 2007; 47 (2): 284–94. DOI: 10.1016/j.jhep.2007.05.001
5. Nousbaum JB, Cadranel JF, Bonnemaison G et al. [Clinical practice guidelines on the use of liver biopsy. (In French).] Gastroenterol Clin Biol 2002; 26 (10): 848–78.
6. Ovchinsky N, Moreira RK, Lefkowitch JH, Lavine JE. Liver biopsy in modern clinical practice: a pediatric point-of-view. Adv Anat Pathol 2012; 19 (4): 250–62. DOI: 10.1097/PAP.0b013e31825c6a20
7. Volynets G.V., Potapov A.S., Poliakova S.I. et al. Opredelenie stepeni narusheniia funktsii pecheni u detei. Voprosy sovremennoi pediatrii. 2013; 12 (4): 47–51. PMID: 26281158 (in Russian).
8. Mayev I.V., Charny A.M., Vyuchnova E.S. et al. Liver biopsy. Teaching aid. Moscow: Publishing house ITRK, 2002 (in Russian).
9. Pokorska-Śpiewak M, Kowalik-Mikołajewska B, Aniszewska M et al. Is liver biopsy still needed in children with chronic viral hepatitis? World J Gastroenterol 2015; 21 (42): 12141–9. DOI: 10.3748/wjg.v21.i42.12141
10. Pintsani M. Evoliutsiia fibroza pecheni: ot gepatita k tsirrozu. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2002; 12 (5): 4 (in Russian).
11. Gagner M, Rogula T, Selzer D. Laparoscopic liver resection: benefits and controversies. Surgl Clin North Am 2004; 84 (2): 451–62. DOI: 10.1016/j.suc.2003.11.002
12. Moy L, Levine J. Autoimmune Hepatitis: A Classic Autoimmune Liver Disease. Cur Probl Ped Adolescent Health Care 2014; 44 (11): 341–6. DOI: 10.1016/J.Cppeds.2014.10.005
13. Aleksandrova E.A., Burnevich E.Z., Arion E.A. Sistemnye proiavleniia pervichnogo skleroziruiushchego kholangita. Klinicheskaia meditsina. 2013; 4: 38–42 (in Russian).
1 ФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*polinakhrolenko@gmail.com
________________________________________________
Polina V. Khrolenko*1, Sergei P. Yatsyk1, Elena Yu. D'yakonova1, Andrei N. Surkov1, Elena L. Tumanova2, Aleksei A. Gusev1, Kirill A. Kulikov1
1 National Medical Research Center of Children’s Health, Moscow, Russia;
2 Pirogov Russian National Research Medical University, Moscow, Russia
*polinakhrolenko@gmail.com