Diffüz karaciğer hastalıkları nedeniyle ayaktan veya yatarak yapılan karaciğer biyopsilerinin analizi

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

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

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.

Keywords:

Outpatient and inpatient liver biopsy, biopsy complications, risk factors,

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