Is anesthesia used during biopsy of liver metastases? Liver biopsy: how it is done, indications. Where can I get the procedure done?

There are percutaneous liver punctures and targeted ones, under the control of a laparoscope or ultrasound. Liver punctures under laparoscope or ultrasound control are most effective for focal liver lesions. At diffuse changes organ tissue, a “blind” biopsy can be used, and although the location of the liver tissue cannot be determined, a high percentage is achieved positive results, and the ease of implementation makes it accessible to any hepatology department.

In case of blood coagulation disorders, massive ascites, small liver size or lack of contact with the patient, as well as fulminant liver failure transjugular liver biopsy is used using a Trucut needle placed in a catheter inserted through jugular vein into the hepatic vein.

Among the puncture needle systems, the most widely used are the Menghini needle and the Trucut needle (a modification of the Silverman needle). A number of other systems are also used.

A liver biopsy is performed with the patient in the supine position. The skin at the puncture site (usually the ninth and tenth intercostal space on the right between the anterior and middle axillary lines) is treated antiseptic solution. After this, local anesthesia of the skin, subcutaneous fatty tissue and liver capsule is performed with a 2% novocaine solution.

The puncture is made with a stylet, inserting it to a depth of 2-4 mm. Then a Menghini puncture needle is inserted through the stylet (in pediatric practice a shortened needle is used), connected to a 10-gram syringe containing 4-6 ml of isotonic sodium chloride solution. The needle is passed to the liver capsule and 2 ml of isotonic sodium chloride solution is released to push pieces of adipose tissue out of the needle. A needle is inserted into the liver parenchyma and pieces of organ tissue are aspirated using the syringe plunger. After the manipulation is completed, a sterile sticker is applied and an ice pack is placed at the puncture site. Within 24 hours the patient retains bed rest.

It is not advisable to perform a liver puncture in case of congestive jaundice, pustular rashes on the skin (especially at the site of the intended puncture). Liver needle biopsy should not be performed against the background of acute respiratory disease, tonsillitis, and other acute infections.

Based on the tissue column obtained during liver biopsy, one can judge changes in the entire organ, especially in diffuse processes ( viral hepatitis, steatosis, reticulosis, cirrhosis, etc.). but a biopsy does not always allow one to diagnose focal liver lesions (granuloma, tumor, abscess, etc.). The absence of portal tracts in the biopsy and the small size of the tissue sample may also be the reason for the lack of information in the biopsy.

The height of the tissue column is 1-4 cm and its weight is 10-50 mg. The tissue sample is usually fixed in a 10% formaldehyde solution in isotonic sodium chloride solution. The preparations are stained with hematoxylin and eosin for the presence connective tissue carry out the CHIC reaction, etc. In addition, tissue columns obtained from paraffin blocks can be subjected to retrospective study. To adequately interpret the results, the tissue sample must be at least 2 cm and contain four portal tracts.

Liver biopsy - that's what it's called diagnostic procedure, which involves collecting cells from a pathological neoplasm. It could be a tumor, polyp or ulcer, for a long time not healing. The tiny pieces of tissue that are taken for analysis are called a biopsy. Various tools can be used to collect it. It all depends on the way the intervention is carried out.

Indications and contraindications for the diagnostic procedure

Before you understand how a liver biopsy is done, it doesn’t hurt to remember the main functions of the organ, its possible diseases. The digestive gland is one of the vital organs. All the basic biochemical reactions that are necessary to maintain normal life body. Without exaggeration, we can say that the structure of the organ is quite complex. The more pressure placed on him, the more vulnerable he becomes.

Interesting! The liver itself has regenerative and restorative properties, but this does not mean that pathological processes cannot develop in it. IN Lately There is an increase in the number of diseases progressing to liver failure.

If you do not apply for it in a timely manner medical care and do not do a liver biopsy, then a violation of the main functions of the organ occurs, this is:

detoxification of the body;
recycling, deactivation of toxic products produced during the metabolic process;
synthesis of biologically necessary for the body active substances, their neutralization in case of obvious excess;
regulation of carbohydrate metabolism.

This is not the entire list of liver functions that are vital for human body. If you do not want to face serious problems, consult a doctor at the slightest sign of discomfort. Properly performed puncture biopsy of the liver early stage development of pathology increases the chances of a speedy recovery.

As for the indications for the described procedure, they largely depend on the type of technique used. Most often, it is used to confirm or deny the presence of diseases, such as:

inflammation of the digestive gland, occurring in acute or chronic form;
pathological replacement of the organ parenchyma with fibrous connective tissue;
alcohol pathology;
increased bilirubin content in skin cells and mucous membranes;
deviations at the genetic level;
tumor;
autoimmune diseases.

To some extent, the price of a liver biopsy depends on the purpose of it. This may also be the need to confirm hepatolienal syndrome, prepare an organ for transplantation, or ensure control after surgery.

The seriousness and complexity of the procedure should not be underestimated. Like any other, it has contraindications, in the presence of which the use of the described diagnostic method is impossible. Obstacles in in this case are:

disturbances in the processes of stopping blood;
bleeding of unknown origin;
diagnosing vascular pathology digestive gland;
neoplasms of echinococcal origin;
excess weight in large quantities (fatty hepatosis);
allergic reaction to anesthetics local action.

We will talk about what the biopsy shows later, but it is impossible to carry it out with stage 4 ascites, infection of the slit-like space between the parietal and visceral layers with right side, you need to remember right now.

Attention! The inability to determine the exact location of the puncture is extremely serious condition patient - all this is also a contraindication.

Types of techniques used

Percutaneous needle biopsy of the liver - it is performed within a few seconds and under local anesthesia, the patient does not feel any discomfort or pain. Tissue samples are taken measuring 1-3 cm in length and 1.2-2 cm in diameter. If we take the total mass of the organ, then the biopsy is 1/50,000 part. If the procedure is performed by an experienced doctor, the risk of complications is minimal. In 0.2% of cases, bleeding occurs due to perforation of the branches of the portal vein. Upon completion of the procedure, patients may feel mild pain, but after the appointment and use of analgesics, the situation quickly stabilizes.
Fine needle aspiration procedure under ultrasound or CT guidance - how is a biopsy sample taken? The puncture area is first numbed using a local anesthetic. The main purpose of the procedure is cytological analysis material for suspected lesions of the digestive gland of a focal type. This also includes malignant tumors. Due to the fact that atypical cells do not dissipate, probability negative consequences Liver biopsy is kept to a minimum.
Transvenous BP - this procedure is suitable for patients diagnosed with a blood clotting disorder. The same applies to those who are undergoing treatment for acute/chronic renal failure using a device (artificial kidney). How is a liver biopsy done in this case? First, a puncture of the jugular vein is made, through which a catheter is inserted into the hepatic vein on the right (the process is controlled by a fluoroscope). Only after this a needle is inserted to take a biopsy.
Laparoscopic - this technique is often used by surgeons to diagnose pathologies associated with ascites and the presence of malignant tumors. In this case it is used general anesthesia. Complications include hemobilia, bleeding, and the formation of a limited accumulation of blood on the anterior abdominal wall. This also includes rupture of the spleen, prolonged pain syndrome, not typical vascular reactions.

How do you prepare for the procedure?

Reviews about the liver biopsy procedure are mostly positive because it provides the most accurate results, low probability of negative consequences. For everything to go well, the patient must properly prepare for it. The action plan is as follows:

a week before the doctor-appointed study date, the patient should stop taking non-steroidal anti-inflammatory drugs if they are taken. You must inform your doctor about therapy using anticoagulants;
3 days before the biopsy, you should stop eating foods that stimulate gas formation. These include bread, dairy products, raw vegetables/fruits. If you have digestive problems, then you need to take enzymes for several days the day before, this way you can prevent bloating by 100%;
the day before, the last meal should not be later than 21.00. It is recommended to do an enema to cleanse the intestines.

Is it painful or not to do a biopsy? As you can already understand, no, because local or general action. Immediately on the day of surgery, blood is drawn from the patient. general analysis, as well as to assess coagulability. Control ultrasounds are also performed, which is necessary to determine the exact location of the biopsy sample. As evidenced by reviews of liver biopsy, it is done strictly on an empty stomach.

Attention! If you need to take any medications regularly medications, you should consult your doctor about this. He will tell you whether you can take the medicine again in the morning.

Progress of the procedure

Most often you can find reviews from patients about puncture-type liver biopsy, because this technique is used most often. The doctor asks the patient to lie on his back, with his right hand behind his head. Anesthesia is administered, the patient must remain motionless. Under ultrasound or CT guidance, a special-purpose needle is inserted inside. This is not to say that the duration of the procedure is long, usually it is 5-10 minutes. Upon completion, the patient remains under observation for some time for 4-24 hours. This condition is met in mandatory, because in this way it is possible to prevent complications of the diagnostic procedure.

As already mentioned, the price of a liver biopsy in Moscow depends on the method used and the complexity of the situation. If we talk about the laparoscopic method, a small incision is made and a special thin tube with a camera at its end is inserted into it. By using such a device, it is possible to thoroughly examine the organ and collect material for research.

Attention! There are situations when it is necessary to insert a catheter into the jugular vein, through which it is directed towards the elastic tubular formations of the digestive gland.

Procedure for evaluating results

Many people are interested in what a biopsy shows? Various methods are used to evaluate the results obtained.

Metavir	used if there are symptoms of hepatitis C. Thus, it is possible to determine the stage of development of inflammation and the degree of damage to the organ. The main indicators are the absence of fibrosis, the presence of its portal form, and spread beyond the portal tracts. This is not the entire list; the only one who can correctly determine the stage of the pathology is a doctor.
Knodell	used when it is necessary to determine the degree of inflammation, namely the index of histological activity, the stage of chronicity of hepatitis of the digestive gland. More precisely, necrosis of the stepped bridge type, the level of intralobular dystrophy, and focal necrosis are subject to evaluation. The doctor must summarize these and other indices into 4 categories.

Regardless of how much this kind of diagnosis costs, it always includes a complete instrumental/laboratory examination before the procedure, prevention internal bleeding through the use of medications. The pricing factor is also the cost of staying in day hospital within 24 hours. Upon completion of the procedure, the patient is given a histological report within a few days. Taking into account the results obtained, the doctor makes a diagnosis, after which he begins to develop treatment tactics for the underlying disease.

Liver biopsy is a procedure aimed at obtaining a tissue sample of this organ for further cytological, histological or bacteriological analysis. The value of this diagnostic technique The point is that other methods of examination are not able to give an extremely accurate answer about the degree of morphological changes in the liver tissue. This study in most cases allows obtaining accurate results, is relatively simple to perform and rarely causes complications.

In this article we will introduce you to the basic methods, indications and contraindications, methods of preparing the patient and the principles of the technique. in various ways liver biopsy. This information will help you understand the essence of this diagnostic method, and you will be able to ask your doctor any questions you may have.

Liver biopsy results are confirmed, clarified, and sometimes changed clinical diagnosis, helping the doctor create the most correct treatment plan for the disease. In some cases, this method is used not only for diagnosis, but also to evaluate the effectiveness of therapy.

According to statistics from the Central Research Institute of Gastroenterology, in which this method of examination was carried out on 8 thousand patients, the preliminary diagnosis chronic hepatitis was confirmed in only 40% of the subjects. In 43% of patients with confirmed hepatitis, liver biopsy helped determine the correct level of activity pathological process: 15% had a more severe stage of liver damage, and 25% had a milder stage. In addition, this diagnostic method made it possible to identify quite rare liver diseases in 4.5% of patients: tuberculosis, Gaucher disease, and hemochromatosis. The percentage of complications arising after liver biopsy was only 0.52% (according to world data medical literature the rate of negative consequences may be 0.06-2%).

Types of liver biopsy

Liver tissue samples can be collected using the following biopsy techniques:

percutaneous puncture biopsy of the liver - the material is obtained blindly by puncturing the anterior abdominal wall and organ with a special Menghini biopsy needle;
fine needle aspiration biopsy liver under CT or ultrasound control - targeted sampling of material is performed with a special needle and under control computed tomograph or ultrasound;
transvenous (or transjugular) liver biopsy is carried out by inserting a special catheter into the jugular vein, which enters the right hepatic vein and collects material;
laparoscopic liver biopsy is performed during diagnostic or therapeutic laparoscopy;
An incisional liver biopsy is done during a classic operation (for example, when removing part of the liver, tumor or metastases).

Indications

A liver biopsy helps verify the diagnosis of many diseases of this organ.

As a rule, a liver biopsy is performed when it is necessary to confirm or clarify the diagnosis and nature of the disease after performing an ultrasound, CT, MRI or PET scan:

The advisability of prescribing a liver biopsy is determined jointly by several doctors: the attending physician and the head of the department or a council meeting.

Before the study, the patient is prescribed the following diagnostic measures:

blood tests: (with determination of platelet levels), for HIV and blood type and Rh factor;
Ultrasound of the liver (if necessary, CT, MRI and PET);

The research results obtained reveal the presence possible contraindications to perform the procedure and determine the most appropriate liver biopsy technique.

After eliminating contraindications, the patient signs informed consent for diagnostics.

Contraindications

Absolute contraindications:

bleeding disorders and;
purulent inflammatory processes in the abdominal or pleural cavity and in the liver;
pustular skin lesions at the puncture site;
biliary or severe portal hypertension;
tense ascites;
mental disorders accompanied by the inability to self-control;
coma;
impossibility of performing blood transfusions to the patient.

In the presence of focal formations in the liver (cysts, tumors, etc.), blind percutaneous liver biopsy is absolutely contraindicated. In such cases, targeted fine-needle biopsy should be performed under CT or ultrasound guidance. Sometimes doctors have to refuse to perform puncture biopsy techniques due to severe obesity and other contraindications.

In some cases, a liver biopsy cannot be performed due to the patient's categorical refusal to undergo this procedure.

Relative contraindications:

inflammatory and infectious diseases V acute stage: bronchitis, cholecystitis, peptic ulcer, etc.);
II-III degrees;
at stage II-III;
ascites;
anemia;
allergic reactions to painkillers.

At relative contraindications the procedure can be carried out after treating the patient or carrying out a special drug correction.

Preparation for the procedure

The question of whether a patient needs to be hospitalized for a liver biopsy is decided by the doctor individually. Puncture types of liver biopsy can be performed in a specially equipped clinic room. After the procedure, the patient will need medical supervision for 4-5 hours or hospitalization for one day is recommended. The remaining studies are carried out in a hospital setting (in the operating room, small operating room or clean dressing room).

The doctor must explain to the patient the essence of the procedure and prepare him psychologically for such an invasive type of examination. If necessary, to eliminate anxiety, the patient may be prescribed sedatives a few days before the biopsy and on the day of the study.

To determine the method of pain relief for the procedure, the patient must inform the doctor about his existing allergic reactions on local anesthetics And medicines. If necessary, a test is performed to determine sensitivity to the anesthetic used and the issue of its possible replacement is decided.

7 days before the procedure, stop taking non-steroidal anti-inflammatory drugs and blood thinners (Aspirin, Diclofenac, Ibuprofen, etc.);
3 days before the biopsy, exclude from the diet foods that promote increased gas formation: brown bread, raw vegetables and fruits, legumes, milk, etc.;
the day before the study, refuse thermal procedures, visits to saunas or steam rooms, hot bath or soul;
if necessary, to eliminate flatulence, drink pancreatic enzymes prescribed by your doctor (Creon, Mezim, etc.) and Espumisan;
dinner the night before the study should be no later than 21:00 (after eating, at least 8-10 hours should pass before the procedure);
perform a cleansing enema (if prescribed by a doctor);
take a hygienic warm shower;
on the morning of the procedure, do not take food or liquids (if the doctor has allowed you to take continuously taken pills before the study, they should be washed down with one sip of water);
on the day or the day before the procedure, take blood tests (general and coagulogram) and undergo an ultrasound;
if hospitalization is planned after the study, then take all medical documentation and things necessary for a comfortable stay in the hospital (comfortable clothes, slippers, etc.).

Principles of performing liver biopsy

Before performing a biopsy nurse shaves the hair in the area of the piercing.

Percutaneous needle biopsy of the liver

The patient lies on his back and slightly tilts his body to the left, and right hand puts it behind his head.
The doctor treats the puncture site with an antiseptic solution and performs local anesthesia.
After the onset of pain relief, the specialist performs a puncture in the area of the 9-10 intercostal space. To make the needle pass more easily, the skin is pierced with a stylet or slightly incised with a scalpel. Before performing a puncture, 3 ml of sterile saline solution is drawn into the syringe to protect the lumen of the needle from entering other tissues. Through the prepared hole, the doctor inserts a puncture needle approximately 3-4 cm until it penetrates the parietal peritoneum. Simultaneously with the advancement of the needle through it, saline. Immediately before collecting the material, about 1.5 ml of saline solution is released from the syringe, which completely frees the lumen of the needle from excess tissue.
To collect a sample of liver tissue, the doctor asks the patient to hold his breath and withdraws the piston of the aspirator syringe all the way to create negative pressure. Next, he performs a rapid penetrating movement into the liver, and the syringe is filled with biopsy material. The organ puncture itself takes approximately 1-2 seconds.
During this time, the biopsy tissue (a column of liver tissue 1-3 cm high) manages to linger in the needle cavity. The doctor immediately removes the needle and treats the puncture site with an antiseptic.
An aseptic bandage is applied to the puncture site and the patient is transported to the ward.
2 hours after the procedure, the patient undergoes an ultrasound of the abdominal cavity to exclude the presence of fluid in the puncture area.

Fine needle aspiration liver biopsy under CT or ultrasound guidance

The patient is placed on his back or left side.
The doctor treats the puncture site with an antiseptic solution and administers local anesthesia.
Using an ultrasound machine or CT scan, the doctor outlines the trajectory of the puncture and makes a pinpoint incision in the skin with a scalpel.
The biopsy needle is inserted under ultrasound or CT guidance. After reaching the required area, the stylet is removed from it and an aspirator syringe filled with 3 ml of sterile saline solution is attached to the needle.
The doctor creates a vacuum in the aspirator syringe and carries out several translational movements to ensure the collection of liver tissue.
The needle is removed from the patient's body, the puncture site is treated with an antiseptic solution and an aseptic bandage is applied to the puncture area.
Before transporting the patient to the ward, a repeat ultrasound is performed to exclude the presence of fluid in the puncture area.

Transvenous liver biopsy

The patient is placed supine and ECG monitoring is provided.
The doctor treats the neck area with an antiseptic solution and administers local anesthesia.
After achieving an analgesic effect, the doctor makes a small incision above the jugular vein and inserts a vascular catheter into it.
The catheter is advanced to the liver under the control of X-ray equipment (fluoroscope). During its passage through the right atrium, the patient may experience arrhythmia. The catheter is advanced along the inferior vena cava to the right hepatic vein.
The doctor inserts a special needle into the catheter and performs a biopsy. At this point, the patient may experience pain in the right shoulder or the biopsy site.
After collecting the material, the catheter is removed from the jugular vein, the puncture site is treated with an antiseptic solution and an aseptic bandage is applied.
The patient is transported to the ward for further medical observation.

Transvenous liver biopsy is performed in cases where direct entry V abdominal cavity is undesirable (for example, with ascites) or the patient has pathologies in the blood coagulation system. This technique reduces the risk of bleeding after the procedure.

Laparoscopic liver biopsy

This method of collecting liver tissue is advisable when it is necessary to perform laparoscopic examinations or operations, with ascites or tumor processes. This intervention is performed under general anesthesia.

The doctor makes small incisions in the skin and through them inserts a laparoscope with a video system into the abdominal cavity and surgical instruments. Tissue collection is performed with special forceps or a loop. When performing this manipulation, the surgeon focuses on the image transmitted to the monitor. After the biopsy, the tissue is cauterized to stop bleeding. Next, the doctor removes the laparoscope and instruments, processes surgical wounds and applies an aseptic dressing. The patient is transported to the ward for further medical observation.

Incisional liver biopsy

This method of liver biopsy is performed during ongoing surgical operations(for example, tumor removal, metastases or atypical liver resection). Excised organ tissue is urgently or routinely sent to the laboratory. If it is necessary to receive test results before completing an intervention, surgeons pause the operation and wait for an answer.

After the procedure

After completing the liver biopsy, the patient is taken to the ward and placed on his right side. The patient should remain in this position for 2 hours. To provide additional pressure on the area of the liver that has undergone intervention, a cushion is placed under the side. If necessary, apply an ice pack to the biopsy area.

After 2-4 hours, the patient is allowed to eat (food should not be hot or rich) and drink liquids. The roller is removed, but over the next 8-10 hours the patient must remain in bed and avoid sudden movements.

He is measured every 2 hours arterial pressure and monitor the pulse. In addition, blood tests are performed to determine the level of hematocrit, hemoglobin and white blood cells. An ultrasound is performed 2 and 24 hours after the procedure to exclude possible complications.

As a rule, a day after minimally invasive liver biopsy techniques are performed, the patient can be discharged from the hospital. Over the next week, the patient should refuse physical activity, taking blood thinning medications and thermal procedures.

IN medical practice behind last years Visual methods of research (ultrasound, x-ray) have been significantly improved. But sometimes they are not enough to make a correct diagnosis. Some pathologies require a tissue sample. To avoid surgery, a liver biopsy is used to obtain cells. How is this procedure done? Why is it prescribed? And how does the research take place?

Let's figure it out.

What is a liver biopsy

This is a special medical study that allows us to identify various abnormalities in the organ at the cellular level.

Let's look into general outline, if a liver biopsy is prescribed, how this procedure is done. Using a special needle, a small piece of tissue is taken and sent for laboratory testing. The procedure is considered a rather complex manipulation.

The question often arises about whether it hurts to do a liver biopsy. The examination causes virtually no discomfort to the patient, since it is performed under anesthesia.

Why is the procedure prescribed?

There is a widespread belief among patients that a liver biopsy is prescribed only if the doctor suspects cancer. But this is far from the only reason why a study may be ordered.

a blood test gives reason to suspect liver disease;
the studies carried out (ultrasound, x-ray, MRI, CT) indicated a problem with the organ;
set degree ;
the patient needs to plan the correct treatment;
after prescribed therapy, the dynamics should be determined.

Remember, if you are scheduled for a liver biopsy, your doctor will explain to you in detail how to do the procedure and why.

The study is prescribed at the most various pathologies, including when:

chronic hepatitis B or C;
alcoholic liver disease;
primary biliary cirrhosis;
autoimmune hepatitis;
primary sclerosing cholangitis;
Wilson-Konovalov disease.

Preparation for the procedure

For a patient scheduled for a liver biopsy, the doctor will explain in detail how to do the procedure. He will explain in detail what to expect from this examination.

The patient should tell the doctor about all the medications he is taking. This applies not only prescription drugs, but also vitamins and herbal supplements.

On the eve of the biopsy, the patient is taken off medications and supplements that can lead to bleeding:

Painkillers such as Aspirin, Ibuprofen.
for example, Warfarin.
Certain nutritional supplements, reducing the risk of sudden bleeding.

In addition to the medications you are taking, it is important to tell your doctor about your health status. Special attention pay attention to the following points:

confirmed or possible pregnancy;
allergic reactions to medications or latex;
recent pneumonia;
do you have ascites;
diseases of the circulatory system.

Before the procedure

After explaining how a liver biopsy is performed (the photo in the article allows you to familiarize yourself with the procedure), the doctor will prescribe the patient an examination:

Blood analysis. It is recommended for the patient to determine the level of blood clotting. If the examination reveals a problem, then immediately before the procedure the doctor will give the person being examined a medicine that reduces the risk of bleeding.
Ultrasound. The study allows you to study anatomical features organ structure.

When all the tests are done, the doctor will schedule a day for the biopsy. You must stop eating 10 hours before the procedure. 8-6 hours before the procedure you should refuse liquids. Immediately before the biopsy, the patient will be advised to void bladder. After all, after the procedure, the patient cannot get up immediately.

Liver biopsy

How is the procedure done?

The manipulation consists of the following stages:

Before the procedure, a sedative is administered intravenously.
The patient will be asked to undress. He lies on his back and puts his right hand under his head.
The area of skin through which the puncture will be performed is disinfected. Local anesthesia is administered to the area.
The doctor, through a manual examination or using an ultrasound machine, will find the liver. A special needle, designed for a puncture biopsy, is inserted through the skin between the two lower right ribs. To facilitate the passage of the needle, the patient may be asked to exhale and hold his breath for a while. Such an event will protect the lung from an accidental puncture.
If necessary, the doctor will perform another puncture, but from a different angle.
The procedure lasts about 15-30 minutes.

If cancer or cirrhosis is suspected, a liver biopsy can be performed in a slightly different way. How is this manipulation done for cancer? A biopsy is sometimes performed during laparoscopy.

Types of procedure

There are several varieties of this manipulation. And only a doctor can tell you how to do a liver biopsy.

Percutaneous biopsy. This is the most common method. This particular method was discussed above.
Transjugular biopsy. The patient lies on his back on the X-ray table. The doctor injects anesthesia into the neck. A small incision is then made and a flexible plastic tube is inserted. It is carefully screwed into the vessel. When the tube reaches it is inserted contrast agent and a series of photographs are taken. A tissue sample is then taken through the tube. The catheter is carefully removed. A bandage is applied to the neck.
Laparoscopic biopsy. The procedure is carried out under general anesthesia. The patient does not feel anything. The patient is positioned on the operating table. The doctor makes several or one small incision in the abdomen. Special instruments are inserted through the incisions, as well as a small video camera that projects an image of the organ on the monitor. The doctor sees the organ in detail. This allows you to take all the necessary tissue samples. After removal of the instrumentation, the incisions are sutured.

After the procedure

Now you know, if a liver biopsy is prescribed, how the procedure is done. Rehabilitation period depends entirely on the type of manipulation.

After the biopsy, the patient is transported to the ward. The nurse monitors the patient's pulse, blood pressure, and breathing.
The person is not allowed to get out of bed for 2-4 hours if a percutaneous biopsy was performed. With other types of procedure, this time increases.
A patient who has been administered sedatives should not drive. It is better to ask your relatives to take you home from the clinic.
You should not lift heavy objects during the day.
Painful sensations at the puncture site may persist for a week.
TO ordinary activities you can return after 1-2 days.

Possible complications

If a biopsy is performed by an experienced doctor, it is a completely safe procedure.

However, sometimes the following consequences may occur:

Pain. Discomfort after the procedure is the most common complication. Most often we are talking about small painful sensations. When severe discomfort The patient is prescribed pain medication.
Bleeding. Some patients may experience this complication. If the bleeding is severe, the patient will require a blood transfusion or surgery.
Infection. Enough rare complication. Bacteria can enter the abdominal cavity through a cut or puncture.
Accidental damage to nearby organs. This is observed extremely rarely. The needle can hurt neighboring organs(lung, gall bladder).

Patients' opinions

Now let’s look at what patients think about such a procedure as liver biopsy. How do they do it?

Liver biopsy

The main goal of a biopsy is to identify the causes of liver disease, the stage of development of the pathology, and the level of damage to the organ. Let's consider what is a liver biopsy?

Removing a small piece of liver tissue for necessary research is called a biopsy. This important analysis to confirm or refute the suspected diagnosis.

Liver puncture is a puncture of an organ to remove a small piece of tissue for further analysis. A small wound remains at the puncture site; the organ itself is not opened.

Preparation for the procedure

The procedure cannot be carried out without thoroughly preparing for it. The preparatory steps are as follows:

A week before the appointed day, you need to stop taking anti-inflammatory drugs. non-steroidal drugs. It is imperative to inform your doctor about the medications you took the day before.
Three days before the procedure, limit to a minimum the intake of foods such as milk, bread, raw vegetables and fruits. These products cause gas formation in the digestive organs, and this is unacceptable for liver biopsy.
The evening before the procedure itself, you should not eat after 21:00. Doctors even force you to do a cleansing enema at night.
Additionally, a control blood test for coagulation and a control ultrasound are performed in order to confirm the location of the upcoming biopsy.
On the day of the procedure, food is not taken; you must stop drinking water 6-8 hours before the start.

Before the procedure, you need to empty your bladder, because you will not be allowed to get up immediately after the operation.

Carrying out the procedure

Liver biopsy is performed in several ways: histological (tissue), cytological (cellular) and bacteriological.

How is a liver biopsy done? The answer depends on how the procedure is performed. There are only three of them, let's look at them.

Percutaneous biopsy

The patient does not experience any particular inconvenience from the procedure, since it is done within just a few seconds and under local anesthesia. The result of the procedure is high – 98%. This is done in two ways:

Using ultrasound analysis, the site for the biopsy is selected - a “blind” method.
The puncture is performed under ultrasound control.

Liver biopsy

For a reliable analysis, a piece of liver 1-3 cm long and 1.2-2 mm in diameter is required.

You should always take into account the fact that only small part diseased organ, so the result of the analysis may not always be reliable.

This type of biopsy is prescribed for the following indications:

jaundice of unknown origin;
diagnosis of liver cirrhosis;
to monitor the treatment of viral hepatitis;
diagnosis of tumor conditions in the body;
diagnosis of hepatitis of all types.

The procedure cannot be performed if tests show low blood clotting, it is impossible to determine the location of the puncture, if vascular tumors, with allergic reactions to medical supplies, for obesity.

The biopsy needle is most often taken from Menghini or Trucut. For puncture, a stylet is used, which penetrates to a depth of 2-4 mm. After this, a needle is inserted into the liver parenchyma through a stylet, which is connected to a syringe filled with isotonic sodium chloride solution. The plunger of the syringe bites off a piece of organ tissue, which is transferred for examination.

Ultrasound-guided fine-needle biopsy

Ultrasound-guided liver biopsy

The puncture site is numbed under local anesthesia. The procedure is performed for focal liver lesions, as well as for suspected cancer. It is practically safe for cancer patients and is possible for echinococcal and vascular lesions.

In an ultrasound-guided liver biopsy, the doctor makes a small incision in the neck and then inserts a plastic tube into the jugular vein. Once the hepatic vein is reached, a special substance is injected into the tube to take pictures. A sample of liver tissue is taken through this tube and carefully removed. A bandage is applied to the neck.

Laparoscopic biopsy

The procedure is performed on the operating table using general anesthesia. Through a small incision in the abdomen, special equipment and a small video camera are inserted into the patient. With its help, the doctor can view the weight of the organ on the monitor screen and select the necessary parts for analysis. After the procedure is completed, all instruments are removed and the incisions are sutured.

After completion of the biopsy

At the end of the procedure, you must follow some rules:

The minimum amount of time that the patient is not allowed to get up is 2-4 hours. During this time it is recommended to lie on your right side;
all this time the nurse must monitor the patient’s pulse, breathing and blood pressure;
You can start eating only 2-4 hours after the procedure;
It is not recommended to lift weights during the day, and on the day of the puncture - to drive.

The patient can return to his normal life within 1-2 days, but at the puncture site he may feel a little sore for another week.

Complications

Liver needle biopsy is safe when performed by an experienced physician. However, sometimes patients still experience some consequences:

pain on the right side that goes away after taking an analgesic;
In rare cases, bleeding may occur. If it doesn't stop long time, the patient requires
surgery or blood transfusion;
through a cut or puncture, bacteria can enter the body, which will lead to the development of diseases;
an inexperienced doctor may accidentally injure neighboring organs.

Liver biopsy is more likely to cause complications in children than in adults. The incidence of complications caused is 4.5%.

Patient reviews of the biopsy vary depending on how the procedure went and whether it left behind any discomfort or complications or not. Before starting the procedure, almost everyone has a fear of the unknown. But performing a biopsy in specialized clinics by experienced doctors leaves, in most cases, positive feedback.

Trephine biopsy

A tube with a pointed end - trephine

Trephine biopsy is the most modern technique examinations. It is used to diagnose diseases of both oncological nature and diseases not related to oncology. To date this method the most accessible and informative.

To carry out the procedure, a special hollow tube with a pointed end is used - a trephine. The procedure is carried out exclusively in an outpatient clinic. Using gentle rotational movements, a trephine is inserted through a small incision to the desired depth, then the needle is removed with the same movements. The section of matter obtained in this way is squeezed out of the trephine and sent to the laboratory for analysis.

Indications for use

A liver biopsy is invariably performed when diagnosing the following diseases:

Liver hyperplasia is an involuntary proliferation of organ tissue cells, a violation of their structure.
Nodular hyperplasia - refers to benign tumors, which over time can increase in size, disrupt the usual way of life, and disrupt the patency of the bile ducts.
Fibronodular hyperplasia is the growth of liver cells in one the only place, also refers to benign tumors. FNH often masquerades as malignant tumors, which greatly complicates the diagnosis.
With hemochromatosis - a violation of the process of iron absorption in the body and its excretion, which disrupts the work of many internal organs. The disease is caused by genetic defects. In other words, the disease is called siderophilia or bronze cirrhosis liver.

The human liver is regenerative in nature, that is, it can fully recover even after very serious illnesses. The main thing is to make the correct diagnosis in time and not delay treatment.

Liver elastometry

Alternative to biopsy

An alternative to biopsy is liver elastometry. Using a special device "Fibroscan", an analysis of the structure of the organ, its morphological and functional indicators is carried out. various diseases. The procedure does not require special training, does not cause discomfort. Absolutely safe method biopsies may be performed more frequently, which allows for research to be carried out when chronic diseases liver. The cost of elastometry is lower than that of biopsy, and the results of both examinations are comparable.

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