Note: The purpose of publishing this specification is to eliminate the need to carry out liver biopsy pathology examination of the patient’s misgivings, as long as the operator in strict accordance with the norms of the implementation of the liver biopsy is in fact very safe. Liver biopsy operation specification 1, indications ① cause of jaundice to be investigated; ② liver function abnormalities of unknown etiology or serology can not determine the cause of the need for intrahepatic pathogenetic examination; ③ hepatomegaly with fever of unknown etiology; ④ chronic viral hepatitis, drug liver disease liver tissue inflammation and fibrosis to determine the degree of; ⑤ alcoholic liver disease and non-alcoholic steatohepatopathies diagnosis and determination of the degree of hepatic tissue fibrosis; ⑦ Splenomegaly or portal hypertension of unknown etiology; ⑧ granulomatous lesions of the liver; ⑨ occupational lesions of the liver of unknown nature; ⑩ ascites of unknown cause. Yi Jianhua, Department of Infection, Wuhan Union Medical College Hospital; Chen Sumei, Department of Infection, Quanzhou First Hospital; 2. Contraindications ① severe coagulation disorders; ② highly obstructive jaundice; ③ cirrhosis with markedly shrunken liver; ④ large amount of/pre-hepatic free ascites or peritoneal infection; ⑤ hepatic siltation or multiple/cavernous hepatic hemangiomas; ⑥ hepatic cystic lesions of unknown nature; ⑦ hepatic amyloidosis; ⑧ uncooperative or coma of the patient. 3, preoperative preparation ① coagulation function tests: including prothrombin time, coagulation time, blood routine and blood type; ② vital signs: temperature, blood pressure, pulse, respiration; ③ ultrasound localization; ④ a large number of / pre-hepatic free ascites or abdominal infection diuretic or anti-infective treatment, until the ascites subsides or the infection is controlled and then carry out the puncture examination of the liver; ⑤ preoperative conversation, the patient or his family to sign the informed consent; ⑥ the patient to do a good job of explaining the work of the patient, the patient or his family members to sign informed consent; ⑥ the patient to make a good explanation. The patient or his/her family should sign an informed consent form. ⑥ Explain the procedure to the patient and teach him/her to breathe. 4, operation procedure ① Selection of puncture point: ultrasound localization to select the right anterior axillary line to the mid-clavicular line of the 7th, 8th, 9th intercostal liver section is larger, avoiding the gallbladder, large blood vessels and the upper and lower edges of the liver; for the obviously enlarged liver can be punctured under the edge of the ribs, selecting the part of the liver that is enlarged or has nodules puncture. ② Position: take the supine position, the right side of the body close to the bedside, the right arm is raised and bent behind the pillow. ③ Disinfection, anesthesia: strict aseptic operation, routine disinfection of the local skin for puncture, the operator wears sterile gloves, spreads sterile perforated towel, and anesthetizes the skin of the puncture point, intercostal muscle, diaphragm and hepatic peritoneum with 2% lidocaine local infiltration layer by layer. Percutaneous puncture: the patient is asked to breathe calmly, the operator holds a “gun-type cutting puncture needle” at the selected puncture point to penetrate the skin and muscle layer into the hepatic peritoneum, the patient is asked to exhale and then hold his/her breath and quickly push the cutting needle core into the hepatic parenchyma, at the same time, the cannula needle automatically cuts the hepatic tissues in an forward motion and quickly pulls out the needle, and the whole process takes only 1-2 seconds. 5, postoperative treatment: ① puncture point to the vitality of iodine sterilized sterile gauze cover and fixed, multi-head abdominal bandage tightly bound ribs and epigastric pressure bandage for 2 hours; ② patients are asked to bed rest for 12 hours, monitor blood pressure, pulse; ③ 3 hours after the operation, it is best to fast or give a small amount of fluid; ④ local pain can be given painkillers; ⑤ a drop in blood pressure, abdominal pain, abdominal muscles, suspected of bleeding, bilious peritonitis, should be immediately asked to take a few days to the patient’s hospital. If there is a drop in blood pressure, severe abdominal pain, abdominal muscle tension, suspected bleeding, cholestatic peritonitis, the patient should be immediately invited to surgical consultation for relevant treatment. The incidence and mortality rate of complications are 5.9% and 0.01%-0.05% respectively. Local pain: generally dull pain, rarely severe pain, mostly less than 24 hours, without special treatment, if necessary, give painkillers such as tramadol 100mg intramuscular injection. ② local bleeding: a dangerous complication, the incidence of serious bleeding is not more than 1%; mostly occurs in coagulation disorders, or rough operation, or puncture into the hepatic peritoneum when the patient’s deep breath to the liver deep and long scratches, etc.; bleeding, medical treatment is ineffective, should be timely surgical treatment. Cholestatic peritonitis: rare, the incidence is less than 0.2%; mostly due to scratching the highly obstructive jaundiced liver, or injury to the gallbladder with variant position; timely surgical treatment should be carried out. Infection: mostly due to poor sterilization or aseptic operation; anti-infection treatment should be given. ⑤ Pneumothorax: rare, mostly due to the high position of puncture point or damage to the lung base caused by puncture under deep inspiration. No special treatment is needed for mild pneumothorax; moderate or severe pneumothorax can be punctured and pumped or chest tube closed drainage can be placed. Shock: rare, mostly hemorrhagic shock, but also painful or allergic shock, can be treated symptomatically.