内镜技术在肝脏疾病诊断治疗中的应用及发展

陆靖怡; 曲颖; 陆伦根

doi:10.12449/JCH240431

内镜技术在肝脏疾病诊断治疗中的应用及发展

DOI: 10.12449/JCH240431

上海交通大学医学院附属第一人民医院消化科，上海 200080

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：陆靖怡负责查阅分析文献，撰写论文；曲颖负责论文修改；陆伦根负责构思文章框架，指导写作及文章定稿。

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通信作者:
陆伦根， lungenlu1965@163.com （ORCID： 0000-0002-1533-4068）

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出版历程
- 收稿日期: 2023-08-16
- 录用日期: 2023-09-18
- 出版日期: 2024-04-25

Application and development of endoscopic techniques in the diagnosis and treatment of liver diseases

Department of Gastroenterology，The First People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine，Shanghai 200080，China

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Corresponding author: LU Lungen， lungenlu1965@163.com （ORCID： 0000-0002-1533-4068）

摘要

摘要: 肝脏疾病是全球最主要的健康问题之一，早期诊断和及时干预治疗是预防肝脏相关疾病发病率和死亡率的关键。内镜技术的发展为肝病的诊断和干预提供了新的手段。本文介绍了超声内镜引导下肝穿刺活检的技术进展与优势，简述内镜技术在治疗肝脓肿/肝囊肿、肝脏疾病引起的门静脉高压以及治疗肝脏肿瘤等介入技术的应用与发展，展示了在国内较为新颖的内镜下减重技术在治疗非酒精性脂肪性肝病/非酒精脂肪性肝炎的功效与前景。内镜技术有望在国内的肝脏相关疾病中得到更好、更广泛的应用与探索，为患者与医生提供更多选择。
- 肝疾病 /
- 内窥镜 /
- 内镜超声引导细针穿刺
Abstract: Liver disease is one of the most important health problems around the world， and early diagnosis and timely intervention and treatment are the key to preventing liver-related morbidity and mortality rates. The development of endoscopic techniques has provided new diagnostic and intervention methods for liver diseases. This article reviews the application and development of endoscopic techniques in liver diseases from the following aspects： the technical advances and advantages of endoscopic ultrasound-guided liver biopsy； the application and development of endoscopic techniques in the treatment of portal hypertension caused by liver abscess/hepatic cyst and liver diseases， as well as interventional techniques in the treatment of liver tumors； the efficacy and prospects of the endoscopic techniques for weight loss， which are relatively new in China， in the treatment of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Endoscopic techniques may hold promise for wide clinical application and exploration in in liver-related diseases in China， so as to provide more options for patients and doctors.
- Liver Diseases /
- Endoscopes /
- Endoscopic Ultrasound-Guided Fine Needle Aspiration

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表 1 临床常见肝穿刺活检方法比较^［2-6］

Table 1. Comparison of common clinical methods of liver biopsy

项目	EUS-LB	经皮肝穿刺活检	经颈静脉肝穿刺活检
可检测的肝叶范围^［3］	双叶	双叶，大部分在右叶	局部右叶
是否可以多模式评估	+++	+	-
标本长度及完整性	++	+++	+
对腹水患者是否安全	是	否	是
对凝血功能异常患者是否安全	是	否	是
穿刺至大血管/其他器官的概率^［5］	小	中	小
是否受肥胖影响^［6］	否	是	否
对小转移灶敏感性	+++	+	-
术后不良反应/并发症风险	+	++	+
价格	++	+	++

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表 2 常见内镜下减重技术^［39-50］

Table 2. Common endoscopic bariatric and metabolic therapies

干预路径	内镜下减重技术	FDA批准	ASMBS认证	对NAFLD疗效
胃相关	胃内球囊置入术（IGB）	√	√	改善^［40-42］
	内镜下袖状胃成形术	√	×	改善^［43］
	内镜胃折叠术	√	×	改善^［44］
	跨幽门梭子装置	√	×	无报道
小肠相关	十二指肠空肠旁路套管	×	×	改善^［45-48］
	十二指肠黏膜表面重修术	×	×	改善^［49-50］
	磁铁下近端空肠-回肠窦道建立术	×	×	无报道
注：FDA，美国食品药品监督管理局；ASMBS，美国代谢和肥胖外科学会。

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