CT引导下经皮肺穿刺活检并发症及处理策略的临床研究
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摘要
目的探讨CT引导下经皮肺活检穿刺并发症的原因、临床表现及处理策略,以期降低并发症风险,保证病人安全。方法回顾分析郑州人民医院2008年6月—2018年6月1190例肺部实性病变在CT引导下经皮肺穿刺活检发生并发症的291例患者,分析发生并发症的原因、症状,总结CT引导下经皮肺穿刺活检的经验及并发症的处理措施。结果所有患者均用巴德可复用活检枪及配套18G活检针进行操作,其中25例二次复穿成功取到满意病变组织后7例发生气胸、4例针道出血,其余均为一次性穿刺。单纯少量气胸93例,气胸并置管9例(肺组织压缩超过30%),气胸伴针道出血45例,单纯针道出血65例,临床表现轻微、少量咯血55例,大量咯血2例并抢救1例,胸腔积液15例,胸膜下血肿4例,发生严重胸膜反应2例,脓胸1例,并发症总发生率24.45%(291/1190)。结论 CT引导下经皮肺穿刺活检术是一项相对安全的诊断性检查,术前认真评估、预判并发症的发生并制定相应处理流程,术中精确定位、穿刺,可以减少并发症的发生,有利于穿刺的成功及病人的安全。
Objective To explore the causes, clinical manifestations and management strategies of complications after CT-guided percutaneous transthoracic lung core biopsy(PTLCB).Methods Complications of 291 patients with the total number of 1190 pulmonary solitary lesions after CT-guided percutaneous transthoracic lung core biopsy(PTLCB) were retrospectively analyzed from JUNE, 2008 to JUNE, 2018. The causes and symptoms of such complications were investigated, and the puncture experiences and management procedures were summarized as well.Results Biopsies of 291 patients with 1190 pulmonary solitary lesions were all performed using the Bard Magnum biopsy gun through a transducer with a slot for the mating biopsy needle(18 G). 25 patients had undergone the second puncture in order to obtain adequate tissue, of which, 7 cases of pneumothotax and 4 cases of needle bleeding occurred after biopsies. The rest of patients all had one time puncture, include a small amount of simple pneumothotax in 93 patients, pneumothotax followed by catheterization in 9 patients(with compression of lung tissue exceeded30%), pneumothotax with concurrence of needle bleeding in 45 patients and simple needle bleeding in 65 patients. Meanwhile, the related clinical manifestations of complications were also recorded, with a small amount of hemoptysis in 55 patients, massive hemoptysis in one patient, pleural effusion in 15 patients, subpleual hematoma in 4 patients, sever pleural reaction in 2 patients and empyema in one patient. The total incidence rate of complications was 24.45%(291/1190).Conclusion CT-guided percutaneous transthoracic lung core biopsy(PTLCB) is a relatively safe diagnostic examination. Careful assessment, prediction of complication and making corresponding process prior to operation, as well as intraoperative precise positioning, can reduce the puncture-related complications.
Objective To explore the causes, clinical manifestations and management strategies of complications after CT-guided percutaneous transthoracic lung core biopsy(PTLCB).Methods Complications of 291 patients with the total number of 1190 pulmonary solitary lesions after CT-guided percutaneous transthoracic lung core biopsy(PTLCB) were retrospectively analyzed from JUNE, 2008 to JUNE, 2018. The causes and symptoms of such complications were investigated, and the puncture experiences and management procedures were summarized as well.Results Biopsies of 291 patients with 1190 pulmonary solitary lesions were all performed using the Bard Magnum biopsy gun through a transducer with a slot for the mating biopsy needle(18 G). 25 patients had undergone the second puncture in order to obtain adequate tissue, of which, 7 cases of pneumothotax and 4 cases of needle bleeding occurred after biopsies. The rest of patients all had one time puncture, include a small amount of simple pneumothotax in 93 patients, pneumothotax followed by catheterization in 9 patients(with compression of lung tissue exceeded30%), pneumothotax with concurrence of needle bleeding in 45 patients and simple needle bleeding in 65 patients. Meanwhile, the related clinical manifestations of complications were also recorded, with a small amount of hemoptysis in 55 patients, massive hemoptysis in one patient, pleural effusion in 15 patients, subpleual hematoma in 4 patients, sever pleural reaction in 2 patients and empyema in one patient. The total incidence rate of complications was 24.45%(291/1190).Conclusion CT-guided percutaneous transthoracic lung core biopsy(PTLCB) is a relatively safe diagnostic examination. Careful assessment, prediction of complication and making corresponding process prior to operation, as well as intraoperative precise positioning, can reduce the puncture-related complications.
引文
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[6] 韦璐,许彪,陈刚,等.16排螺旋CT及三维重建技术在细针经皮肺穿刺活检中运用40例分析[J].中国误诊学杂志,2008,8(25) :6215-6216.
[7] 许彪,陈刚,韦璐,等.多层螺旋CT导向经皮肺穿刺活检的临床应用[J].医学影像学杂志,2008,18(11):1336-1338.
[8] Himsawa S,Hirasawa H,Taketomi-Takahashi A,et a1.Air embolism detected during computed tomography flnuoroscopically guided tran-thoracic needle biopsy[J].Cardiovasc Intervent Radiology,2008,31(1):219-221.
[9] 李群,王嗣伟,李若梅,等.CT引导下经皮肺穿刺活检的临床价值[J].中国CT和MRI杂志,2011,9(1):7-9.
[10] Cruz J F,Rolo R,Iglesias L,et al.CT-guided transthoracic Lung biopsy:predictive factors of pneumothorax [J].Rev Port Pneumol,2014,20(3):174-176.
[11] Yeow KM,Su IH,Pan KT,et al.Risk factors of pneumothorax and bledding:multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies [J].Chest,2004,126(3):748-754.
[2] Al-Damegh S.Fine needle aspiration of solitary pulmonary lesions[J].Eur J Radol,2001,37(3):200-203.
[3] 董其龙,李志达,李天然,等.肺部周围型肿块CT引导下经皮穿刺活检病理对照研究[J].介入放射学杂志,2004,13(6):544-545.
[4] 代文静,何彬普,孙建,等.CT引导下肺部小结节(≤1cm)穿刺活检术结果分析[J].中华肺部疾病杂志,2015,8(4):44-46.
[5] Choo CM,Park NK,Lee SM,et al.Percutaneous transthoracic needle biopsy of small (≤1cm) lung nodules under C-arm conebeam CT virtual navigation guidance [J].European,2013,23(3):712-719.
[6] 韦璐,许彪,陈刚,等.16排螺旋CT及三维重建技术在细针经皮肺穿刺活检中运用40例分析[J].中国误诊学杂志,2008,8(25) :6215-6216.
[7] 许彪,陈刚,韦璐,等.多层螺旋CT导向经皮肺穿刺活检的临床应用[J].医学影像学杂志,2008,18(11):1336-1338.
[8] Himsawa S,Hirasawa H,Taketomi-Takahashi A,et a1.Air embolism detected during computed tomography flnuoroscopically guided tran-thoracic needle biopsy[J].Cardiovasc Intervent Radiology,2008,31(1):219-221.
[9] 李群,王嗣伟,李若梅,等.CT引导下经皮肺穿刺活检的临床价值[J].中国CT和MRI杂志,2011,9(1):7-9.
[10] Cruz J F,Rolo R,Iglesias L,et al.CT-guided transthoracic Lung biopsy:predictive factors of pneumothorax [J].Rev Port Pneumol,2014,20(3):174-176.
[11] Yeow KM,Su IH,Pan KT,et al.Risk factors of pneumothorax and bledding:multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies [J].Chest,2004,126(3):748-754.