1. indications ① the cause of jaundice is to be investigated; ② the cause of abnormal liver function is unknown or the cause cannot be determined by serology and requires intrahepatic pathogenic examination; ③ the cause of hepatomegaly with fever is unknown; ④ the determination of the degree of inflammation and fibrosis of liver tissue in chronic viral hepatitis and drug-related liver disease; ⑤ the diagnosis of alcoholic liver disease and non-alcoholic fatty liver disease and the determination of the degree of fibrosis of liver tissue; ⑦ the cause of splenomegaly or portal hypertension unknown; ⑧ granulomatous lesions of the liver; ⑨ occupying lesions of the liver of unknown nature; ⑩ ascites of unknown cause. Department of Infection, Wuhan Union Medical College Hospital, Yi Jianhua 2. Contraindications ①severe coagulation dysfunction; ②highly obstructive jaundice; ③significant liver shrinkage in cirrhosis; ④massive/prehepatic free ascites or abdominal infection; ⑤hepatic stasis or multiple/cavernous hepatic hemangiomas; ⑥hepatic cystic lesions of unknown nature; ⑦hepatic amyloid lesions; ⑧patient uncooperative or coma. 3. preoperative preparation ①coagulation function tests: including ② Vital signs examination: temperature, blood pressure, pulse, respiration; ③ Ultrasound localization; ④ Diuretic or anti-infective treatment for massive/prehepatic free ascites or abdominal infection, and liver puncture after ascites subsides or infection control; ⑤ Pre-operative conversation, patient or his family sign informed consent; ⑥ Make good explanation to the patient and teach the patient to 4. operation steps ① select the puncture site: choose the larger liver section between the right anterior axillary line and the 7th, 8th and 9th ribs of the midclavicular line by B ultrasound positioning, avoiding the gallbladder, large blood vessels and the upper and lower edges of the liver; for the obviously enlarged liver, puncture can be done under the rib margin, and choose the site with enlargement or nodules. ②Position: take a supine position, the right side of the body near the bedside, and the right arm is raised and bent behind the pillow. Sterilization and anesthesia: strictly aseptic operation, routine sterilization of the local skin of the puncture site, the operator wears sterile gloves, spreads sterile hole towel, and anesthetizes the skin of the puncture site, intercostal muscle, diaphragm and liver peritoneum with 2% lidocaine local infiltration layer by layer. ④Percutaneous puncture: Ask the patient to breathe calmly, the operator holds the “gun-type cutting needle” at the selected puncture point to penetrate the skin and muscle layer into the liver peritoneum, ask the patient to exhale and hold his breath, then quickly push the cutting needle core into the liver parenchyma, while the trocar needle automatically cuts the liver tissue forward and quickly withdraws the needle, the whole process only takes 1-2 seconds. 5. Postoperative management: ① the puncture site should be covered with sterile gauze and fixed after sterilization with vital iodine, and the multi-headed lap band should be tightly wrapped around the ribs and upper abdomen with pressure for 2 hours; ② the patient should be asked to rest in bed for 12 hours, and blood pressure and pulse should be monitored; ③ it is better to fast or give a small amount of fluid within 3 hours after surgery; ④ local pain can be given painkillers; ⑤ if there is a drop in blood pressure, severe abdominal pain, abdominal muscle tension, suspected bleeding or biliary peritonitis The incidence and mortality rate of complications and management of complications are 5.9% and 0.01%-0.05%, respectively. ①Local pain: generally dull pain, rarely severe pain, mostly not more than 24 hours, no special treatment is needed, if necessary, give analgesic drugs such as tramadol 100mg intramuscular injection. ②Local bleeding: it is a dangerous complication, the incidence of serious bleeding does not exceed 1%; it mostly occurs due to coagulation dysfunction, or rough operation, or deep breathing of the patient when puncturing the needle into the liver peritoneum resulting in a deep and long cut to the liver, etc.; when bleeding is large and medical treatment is ineffective, surgical treatment should be promptly performed. (③Cholestatic peritonitis: rare, with an incidence of less than 0.2%; mostly due to scratching of the liver with high obstructive jaundice or injury to the variably located gallbladder; prompt surgical treatment should be performed. ④Infection: Mostly due to poor sterilization or aseptic operation; should be treated with anti-infection therapy. ⑤ Pneumothorax: rare, mostly due to high puncture point position or injury to the lung base caused by puncture under deep inspiration. Mild pneumothorax does not require special treatment; moderate or severe pneumothorax can be treated by puncture and suction or by placing closed chest tube drainage. (6) Shock: rare, mostly hemorrhagic shock, but also painful or anaphylactic shock, which can be treated symptomatically. Note: The purpose of publishing this practice is to eliminate the concerns of patients who need to perform liver biopsy pathology, and liver biopsy is actually very safe as long as the operator strictly follows the specifications.