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目的 探讨肝活检及病理检查在小儿肝脏疾病中的临床诊断价值。方法 采用可调式MAG-GNUMTM活检枪对30例小儿不同病因的肝病进行肝活检,肝组织进行光镜与电镜检查,慢性乙肝23例进行组织病理分级分期诊断。结果 肝活检成功率100％。6.67％有术后穿刺部位疼痛,无其他并发症。慢性乙肝23例,病理分级G1 11例(47.8％),G2 9例(39.1％),G3 3例(13.0％)。纤维化程度分期S0 10例(43.5％),S1 8例(34.8％),S2 3例(13.0％)、S3、S4各1例(4.35％)。电镜检查对慢性乙型肝炎纤维化能早期发现,对肝糖原累积症、EB病毒感染有特异性发现。结论 MAGGNUMTM活检枪在儿童应用安全、成功率高。小儿慢性乙型病毒性肝炎炎症与纤维化程度低炎症分度以G1、G2多见,纤维化分期为S0、S1为主,光镜与电镜结合检查在小儿肝脏疾病有重要诊断价值。
Objective To investigate the clinical value of liver biopsy and pathological examination in pediatric liver disease. Methods Liver biopsy was performed in 30 children with different etiology of liver disease using a modified MAG-GNUMTM biopsy gun. The liver tissues were examined by light microscopy and electron microscopy. Twenty-three patients with chronic hepatitis B were diagnosed by histopathological grading and staging. Results The success rate of liver biopsy was 100%. 6.67% postoperative puncture site pain, no other complications. There were 23 cases of chronic hepatitis B, 11 cases of pathological grading G1 (47.8%), 9 cases of G2 (39.1%) and 3 cases of G3 (13.0%). Fibrosis stage S0 10 cases (43.5%), S1 8 cases (34.8%), S2 3 cases (13.0%), S3 and S4 1 case (4.35%). Electron microscopy of early detection of chronic hepatitis B fibrosis can be found on liver glycogenosis, Epstein-Barr virus infection. Conclusion MAGGNUMTM biopsy gun is safe in children with high success rate. Inflammation and fibrosis in children with chronic hepatitis B and a low degree of inflammation to G1, G2 more common, fibrosis staging S0, S1-based, light microscopy and electron microscopy in the diagnosis of pediatric liver disease has important diagnostic value.