試作生検針を用いた経内頸静脈的肝生検法による診断成績

独自に試作した生検針を用いて経内頸静脈的肝生検を各種肝疾患125症例に施行した.生検針は原法で用いるRoss針とは刃先の切り口を逆側とし,スタイレットを備え,針先端の曲率半径R=90mmとR=60mmの二種類を作製した.125例中の123例で肝組織が採取でき,107例で正診が得られた〔sensitivity 87.0% (CI 81.1～92.9%, P=0.05), specificity 97.1% (CI94.1～100%, P=0.05), overall accuracy 94.4% (CI 90.3～98.5%, P=0.05)〕.肝硬変76症例では60例,78.9%で正診が得られ...

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Published in肝臓 Vol. 34; no. 5; pp. 400 - 406
Main Authors 多田, 教彦, 松坂, 聡, 小林, 正文, 金沢, 秀典
Format Journal Article
LanguageJapanese
Published 一般社団法人　日本肝臓学会 1993
Subjects
出血傾向
経内頸静脈的肝生検
肝硬変
腹水
Online AccessGet full text
ISSN0451-4203
1881-3593
DOI10.2957/kanzo.34.400

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Abstract 独自に試作した生検針を用いて経内頸静脈的肝生検を各種肝疾患125症例に施行した.生検針は原法で用いるRoss針とは刃先の切り口を逆側とし,スタイレットを備え,針先端の曲率半径R=90mmとR=60mmの二種類を作製した.125例中の123例で肝組織が採取でき,107例で正診が得られた〔sensitivity 87.0% (CI 81.1～92.9%, P=0.05), specificity 97.1% (CI94.1～100%, P=0.05), overall accuracy 94.4% (CI 90.3～98.5%, P=0.05)〕.肝硬変76症例では60例,78.9%で正診が得られた〔sensitivity 78.9% (CI 69.7～88.1%, P=0.05).specificity 100%, overall accuracy 87.0% (CI 79.4～94.6%, P=0.05)〕.正診できなかった原因は採取組織のfragmentationであった.その他の肝疾患では全例で正診が得られた.経皮的肝生検禁忌であった57例でも44例で正診が得られた.肝被膜の穿孔を2症例に認めた以外に重篤な合併症はなく,本生検針を使用した経内頸静脈的肝生検法は安全で有用な手技と考えられた.
AbstractList 独自に試作した生検針を用いて経内頸静脈的肝生検を各種肝疾患125症例に施行した.生検針は原法で用いるRoss針とは刃先の切り口を逆側とし,スタイレットを備え,針先端の曲率半径R=90mmとR=60mmの二種類を作製した.125例中の123例で肝組織が採取でき,107例で正診が得られた〔sensitivity 87.0% (CI 81.1～92.9%, P=0.05), specificity 97.1% (CI94.1～100%, P=0.05), overall accuracy 94.4% (CI 90.3～98.5%, P=0.05)〕.肝硬変76症例では60例,78.9%で正診が得られた〔sensitivity 78.9% (CI 69.7～88.1%, P=0.05).specificity 100%, overall accuracy 87.0% (CI 79.4～94.6%, P=0.05)〕.正診できなかった原因は採取組織のfragmentationであった.その他の肝疾患では全例で正診が得られた.経皮的肝生検禁忌であった57例でも44例で正診が得られた.肝被膜の穿孔を2症例に認めた以外に重篤な合併症はなく,本生検針を使用した経内頸静脈的肝生検法は安全で有用な手技と考えられた.
Author 小林, 正文
金沢, 秀典
松坂, 聡
多田, 教彦
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References 2) Dotter CT: Catheter biopsy. Experimental technic for transvenous liver biopsy. Radiology 82: 312-314, 1964
11) Steadman C, Nathan N, Teague C: Transjugular liver biopsy-An Australian experience. Aust NZ J Med 18: 836-840, 1988
4) 金沢秀典,多田教彦,松坂聡,他:経内頸静脈的肝生検の経験.日消誌 84: 2419, 1987
3) Lebrec D, Goldfarb G, Degott C: Transvenous liver biopsy. An experience based on 1,000 hepatic tissue samplings with this procedure. Gastroenterology 83: 338-340, 1982
10) Gamble P, Colapinto RF, Stronell RD: Transjugular liver biopsy: A review of 461 biopsies. Radiology 157: 589-593, 1985
16) McGill DB, Rakela J, Zinsmeister AR: A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology 99: 1396-1400, 1990
8) Matzen P, Henriksen JH, Christoffersen P: Transvenous liver biopsy in patients with bleeding tendency. Dan Med Bull 26: 175-178, 1979
7) Goldman ML, Gonzalez AC, Galambos JT: The transjugular technique of hepatic venography and biopsy, cholangiography, and obliteration of esophageal varices. Radiology 128: 325-331, 1978
6) Bull HJM, Gilmore IT, Bradley RD: Experience with transjugular liver biopsy. Gut 24: 1057-1060, 1983
9) Velt PM, Choy OG, Shimkin PM: Transjugular liver biopsy in high-risk patients with hepatic disease. Radiology 153: 91-93, 1984
14) Lebrec D, Degott C, Rueff B: Transvenous (transjugular) liver biopsy. An experience based on 100 biopsies. Dig Dis 23: 302-304, 1978
13) Furuya KN, Burrows PE, Phillips MJ: Transjugular liver biopsy in children. Hepatology 15: 1036-1042, 1992
1) Weiner M, Hanafee WN: A review of transjugular cholangiography. Radiol Clin North Am 8: 53-68, 1970
5) Hanafee W, Weiner M: Transjugular percutaneous cholangiography. Radiology 88: 35-39, 1967
15) Piccinino F, Sagnelli E, Pasquale G: Complications following percutaneous liver biopsy. A multicentre retrospective study on 68, 276 biopsies. J Hepatol 2: 165-173, 1986
17) Scotto J, Opolon P, Étévé J: Liver biopsy and prognosis in acute liver failuer. Gut 14: 927-933, 1973
12) McAfee JH, Keeffe EB, Lee RG: Transjugular liver biopsy. Hepatology 15: 726-732, 1992
References_xml – reference: 10) Gamble P, Colapinto RF, Stronell RD: Transjugular liver biopsy: A review of 461 biopsies. Radiology 157: 589-593, 1985
– reference: 17) Scotto J, Opolon P, Étévé J: Liver biopsy and prognosis in acute liver failuer. Gut 14: 927-933, 1973
– reference: 5) Hanafee W, Weiner M: Transjugular percutaneous cholangiography. Radiology 88: 35-39, 1967
– reference: 14) Lebrec D, Degott C, Rueff B: Transvenous (transjugular) liver biopsy. An experience based on 100 biopsies. Dig Dis 23: 302-304, 1978
– reference: 3) Lebrec D, Goldfarb G, Degott C: Transvenous liver biopsy. An experience based on 1,000 hepatic tissue samplings with this procedure. Gastroenterology 83: 338-340, 1982
– reference: 15) Piccinino F, Sagnelli E, Pasquale G: Complications following percutaneous liver biopsy. A multicentre retrospective study on 68, 276 biopsies. J Hepatol 2: 165-173, 1986
– reference: 8) Matzen P, Henriksen JH, Christoffersen P: Transvenous liver biopsy in patients with bleeding tendency. Dan Med Bull 26: 175-178, 1979
– reference: 13) Furuya KN, Burrows PE, Phillips MJ: Transjugular liver biopsy in children. Hepatology 15: 1036-1042, 1992
– reference: 9) Velt PM, Choy OG, Shimkin PM: Transjugular liver biopsy in high-risk patients with hepatic disease. Radiology 153: 91-93, 1984
– reference: 7) Goldman ML, Gonzalez AC, Galambos JT: The transjugular technique of hepatic venography and biopsy, cholangiography, and obliteration of esophageal varices. Radiology 128: 325-331, 1978
– reference: 4) 金沢秀典,多田教彦,松坂聡,他:経内頸静脈的肝生検の経験.日消誌 84: 2419, 1987
– reference: 16) McGill DB, Rakela J, Zinsmeister AR: A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology 99: 1396-1400, 1990
– reference: 1) Weiner M, Hanafee WN: A review of transjugular cholangiography. Radiol Clin North Am 8: 53-68, 1970
– reference: 12) McAfee JH, Keeffe EB, Lee RG: Transjugular liver biopsy. Hepatology 15: 726-732, 1992
– reference: 11) Steadman C, Nathan N, Teague C: Transjugular liver biopsy-An Australian experience. Aust NZ J Med 18: 836-840, 1988
– reference: 6) Bull HJM, Gilmore IT, Bradley RD: Experience with transjugular liver biopsy. Gut 24: 1057-1060, 1983
– reference: 2) Dotter CT: Catheter biopsy. Experimental technic for transvenous liver biopsy. Radiology 82: 312-314, 1964
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Snippet 独自に試作した生検針を用いて経内頸静脈的肝生検を各種肝疾患125症例に施行した.生検針は原法で用いるRoss針とは刃先の切り口を逆側とし,スタイレットを備え,針先端の曲率半径R=90mmとR=60mmの二種類を作製した.125例中の123例で肝組織が採取でき,107例で正診が得られた〔sensitivity...
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StartPage 400
SubjectTerms 出血傾向
経内頸静脈的肝生検
肝硬変
腹水
Title 試作生検針を用いた経内頸静脈的肝生検法による診断成績
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