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肝脏成像与活检在临床实践中的应用
Use of Liver Imaging and Biopsy in Clinical Practice


Elliot B. Tapper ... 其他 • 2017.08.24

无创检测可否替代肝脏穿刺活检

 

陆荫英

解放军第302医院

 

肝脏穿刺活检一直都被认为是判断肝病病因及严重程度最为特异性的检测手段之一,为制订临床治疗方案、判定预后提供了重要的信息1。在过去10多年中,随着影像学技术的进步、血清学标志物的发展,越来越多的患者可通过无创检测来完成病情的评价,从而避免了有创的肝脏穿刺活检。但是,两者对于判断肝病病因、肝结节性质、肝纤维化/肝硬化分级等的临床实际意义仍待探讨2

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肝活检既往被用于确定肝病的病因和分期,以及指导治疗决策和明确预后。在2001年,Bravo等人观察到“肝活检通常是评估肝病性质和严重程度的特异性最高的检测”1。然而,在过去的16年间,肝活检的临床应用发生了深刻变革。对活检费用和并发症风险的担忧促使经过验证的肝活检替代方法越来越多。此外,研究也对肝活检的局限性带来了新的认识。我们在本综述中讨论肝活检在当代的价值、无创评估手段的准确性,及其在确定肝病和局灶性肝脏病变的病因及检测晚期纤维化和肝硬化方面的临床应用。





作者信息

Elliot B. Tapper, M.D., and Anna S.-F. Lok, M.D.
From the Division of Gastroenterology and Hepatology and the Institute for Healthcare Policy and Innovation, University of Michigan (E.B.T., A.S.-F.L.), and the Veterans Affairs Hospital (E.B.T.) — both in Ann Arbor. Address reprint requests to Dr. Tapper at 3912 Taubman Center, SPC 5362, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, or at etapper@umich.edu.

 

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