What is Liver Puncture? What is the purpose of liver puncture? Liver puncture is the abbreviation of liver puncture biopsy, the purpose is to understand the etiology and pathogenesis of liver disease, to determine the diagnosis and to provide a basis for the development of treatment plans. For patients with hepatitis B, the purpose of liver puncture is mainly to assess the grading and staging of chronic hepatitis, i.e., the degree of liver inflammation and fibrosis, in order to guide the antiviral treatment of hepatitis B. In particular, patients who are ready to receive interferon therapy should be treated with a liver biopsy biopsy to determine the cause of the disease. Especially for hepatitis B patients who are ready to receive interferon therapy, it is more meaningful to have a liver puncture because the degree of liver lesions is correlated with the effectiveness of interferon therapy. The liver is a silent organ, and when there is mild inflammatory activity in the liver, it can show no clinical signs, so that there may be a situation in which the clinical manifestations do not coincide with the pathological changes in the liver. For example, in some cases, liver inflammation potentially develops and lasts for a long period of time, and although there is no obvious clinical manifestation, liver pathology shows heavy lesions after liver puncture. Generally speaking, liver tissue lesions in cases with heavy clinical manifestations are also heavier; however, liver tissue lesions with light clinical manifestations may not be light, therefore, liver puncture is very important in determining the severity of the disease. Under what circumstances do hepatitis B patients need to do liver puncture Under what circumstances do hepatitis B patients need to do liver puncture? Not all hepatitis B virus-infected patients need to have a liver puncture. Whether or not to have a liver puncture should be considered according to the patient’s age, the quantitative amount of the hepatitis B virus, liver function, and “major and minor triple positive”, etc. For chronic hepatitis B virus-infected patients, liver puncture is the most effective way to determine the severity of the disease. For chronic hepatitis B virus infected patients, no matter “major or minor triple positive”, if the liver function is persistently or repeatedly abnormal, and the viral quantification is more than 1000 copies/ml, liver biopsy should be considered, especially for those who are going to receive interferon antiviral therapy. The vast majority of patients who undergo liver biopsy in our department are ready to start interferon antiviral therapy. So, is it not necessary to do a liver puncture when the liver function is normal? In this case, the decision depends on the quantification of the hepatitis B virus, the E antigen status and the age of the patient. If the patient is “minor triple positive”, positive for hepatitis B virus, older than 40 years of age, and has an ALT level at the high end of the normal range, liver puncture should be considered, as this group of patients may have underlying hepatitis activity. It is important to note here that liver puncture is not necessary in patients who have already been diagnosed with cirrhosis or who already have more evidence supporting cirrhosis. Are the results of a liver puncture the “gold standard” for diagnosing liver disease? To diagnose liver disease, imaging and serology have their own advantages and can reflect the extent of the lesion from different perspectives. As far as current diagnostic methods are concerned, the results of liver histology, i.e., liver puncture, are the most reliable for the diagnosis of liver diseases. Therefore, many people regard liver puncture biopsy as the “gold standard” for diagnosis. However, even if it is the “gold standard”, it is only relative, because the specimen taken out by liver puncture is very small, usually 1-2 cm in length, about 1/2,000,000 of the weight of the whole liver, and the distribution of the lesions in chronic liver diseases is not uniform, so sampling errors may occur. In patients with cirrhosis, due to the heavy degree of liver fibrosis, it is possible that only the liver parenchyma is taken during the puncture operation and the fibrous tissue is missed, resulting in the missed diagnosis of cirrhosis, which is about 20%. What are the contraindications to liver puncture? People with bleeding tendency, such as hemophilia, platelet less than 70~109/L, prothrombin activity (PTA%) <50%, are the main contraindications to liver puncture; other contraindications include severe jaundice, large amount of ascites and so on. Is liver puncture safe? What are the complications? When the doctor mentions liver puncture, there are many patients who are nervous and apprehensive, worrying that liver puncture may be dangerous or that it may be harmful to the liver. This is due to a lack of necessary knowledge about liver puncture. In fact, liver puncture is generally quite safe, although some complications may occur, but as long as the indications and contraindications are well mastered, the operation is skillful, and the preoperative preparations are well done, most of the complications can be avoided. As for the damage to the liver, it is actually very slight or even negligible. The liver tissue taken by the hepatic puncture needle is only 1-3cm in length and about 2mm in width, which is "a drop in the bucket" for the whole liver, and the liver has strong regenerative ability and can heal very quickly. Common complications of liver puncture include localized pain, epigastric discomfort, nausea, drop in blood pressure, etc., which can be quickly relieved after treatment. Other rare complications include infection, bleeding, and subdiaphragmatic abscess.