Analysis of liver biopsies performed as outpatient and ınpatient, due to diffuse liver diseases

Yıl 2018, Cilt: 10 Sayı: 3, 331 - 342, 30.09.2018

Özlem Gül Utku , Ahmet Bektaş

https://doi.org/10.21601/ortadogutipdergisi.397750

Öz

Aim: Liver biopsy is a procedure carried out to
diagnose and grade the liver disease, to estimate the prognosis and to give the
decision of treatment. Despite the developing imaging techniques, serological
findings used in diagnosis of liver disease and all the other laboratory
facilities, the requirement for liver biopsy has not declined, on the contrary
it has increased, appearing in a different characteristic. İn this study, we
investigated the indications and complications of the liver biopsy, the factors
upon which the complications depend, the adequacy of biopsies performed, the
cost of biopsies, whether all these factors create a discrepancy between the
groups.

Material
and Method: İn this
retrospective study, the files of 553 patients, 213 (38,5%) of whom were outpatients
and 340 (61,5%) of whom were inpatients, were screened. When the results of the
complete blood count, routine biochemistry, INR and PT carried out before the
biopsy were assessed, there was no significant difference between two groups
except for the results of albumin, creatinin and alkaline phosphatase.

Results:
Albumin was high in the outpatient group,
whereas creatinin was high in the inpatient group. Menghini needle was used in
98 % of 213 outpatients and tru-cut needle was used in 1,9% of 213 outpatiens,
While tru-cut needle was used in 99,1% of 340 inpatients, Menghini needle was
used in 0,9% of 340 inpatients. Minor complications were observed in 18,3% of
outpatients and 40,2% of inpatients (p<0,05). Although no majör
complications were observed in the outpatients, they were observed in the 6
(1,7%) inpatients (p<0,05). Complications were associated with the
experience of the physician, the number of passes, the use of tru-cut needle,
the prolongation of PT value, trombocyte count below 80000/mm3, the INR value
over 1,2. The average cost of outpatient biopsy was 137±22 YTL, while it was
214±11 YTL inpatient (p<0,05).

Conclusion: Consequently, the outpatient liver biopsies
performed by the experienced staff are both safer and less expensive than the
inpatient liver biopsies. Post liver biopsy complications are associated with
the experience of physician, the method, the number of passes, disorders of
hemostasis.

Anahtar Kelimeler

Outpatient and inpatient liver biopsy, biopsy complications, risk factors

Diffüz karaciğer hastalıkları nedeniyle ayaktan veya yatarak yapılan karaciğer biyopsilerinin analizi

Öz

Giriş: Karaciğer
biyopsisi karaciğer hastalıklarının tanısı, evrelendirilmesi, prognozun tahmini
ve hastaların tedavi kararlarının verilmesi için yapılan bir işlemdir.
Günümüzde gelişen görüntüleme yöntemleri, karaciğer hastalığının tanısında
yararlandığımız serolojik göstergeler ve diğer bütün laboratuvar olanaklarına
rağmen karaciğer biyopsisine duyulan gereksinim azalmamış, tersine nitelik
değiştirmesine rağmen artmıştır.

Gereç
ve Yöntem: Bu çalışmada hastanemizde Ocak 1998 ve Haziran
2007 tarihleri arasında, ayaktan ve yatarak yapılan karaciğer biyopsilerinin
endikasyonları, komplikasyonları, biyopsilerin maliyetleri retrospektif olarak değerlendirildi.

Bulgular:
Ayaktan biyopsi yapılan 213 (%38,5) hasta ile
yatarak biyopsi yapılan 340 (%61,5) hasta değerlendirilmeye alındı. Ayaktan
biyopsi yapılan hastalarda majör komplikasyon görülmezken; yatarak biyopsi
yapılan hasta grubunda 6 (%1,7) hastada tespit edildi (p<0,05).
Komplikasyonların bağlı olduğu faktörler hekimin tecrübesi, işlem sayısı, tru-cut
iğne kullanımı, PT değerinde 4 sn ve üzerindeki uzamalar, trombosit değerinin
80000/mm³ ve altında olması, INR değerinin 1,2 ve üzerinde
olmasıdır. Her iki grup içinde 192 hastanın maliyet kayıtlarına ulaşılabildi.
Ayaktan biyopsi yapılan grubun ortalama maliyeti 137±22YTL, yatarak biyopsi
yapılan grubun 214±11YTL idi (p<0,05).

Sonuç: 
Tecrübeli ellerde ayaktan yapılan karaciğer biyopsileri, en az yatarak
yapılan karaciğer biyopsileri kadar güvenli ve maliyeti de daha düşüktür.
Karaciğer biyopsisi sonrası komplikasyonlar hekimin tecrübesi, yöntem, işlem
sayısı, hemostaz bozuklukları ile bağlantılı bulunmuştur.

Anahtar Kelimeler

Ayaktan ve yatarak karaciğer biyopsisi, biyopsi komplikasyonları, risk faktörleri

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