CT导向下经皮肺穿刺活检并发症的预防及处理

Prevention and treatment of complications associated with CT-guided percutaneous transthoracic needle biopsy

目的 探讨CT导向下经皮肺穿刺活检术的并发症及其预防和处理。方法 对 168例肺部疑难病变行CT导向下经皮肺穿刺活检术 ,分析并发症的种类、主要并发症发生的影响因素 ,以及并发症的预防和处理措施。结果 168例穿刺成功 ,并发症主要为气胸 14例 ,肺出血 3 4例 ,除 1例气胸较大量外 ,其余均为少量。气胸与病灶大小、部位及穿刺次数有关 ,出血与病灶大小及术前是否增强有关。少量出血或气胸无需处理 ,大量气胸需置管引流。结论 对于CT导向下经皮肺穿刺活检术的并发症 ,应以预防为主 ,而预防的关键在于术前准确的定位和对血管的评估 ,以及术中熟练的操作。

Objective To investigate the prevention and treatment of the complications due to CT-guided percutaneous transthoracic biopsy. Methods CT-guided percutaneous transthoracic needle biopsy was performed in 168 patients aged from 14 to 79 years old. The complications and the contributing factors were analyzed. The methods for the prevention and treatment of the complicaitons were suggested. Results CT-guided percutaneous transthoracic needle biopsy was succeeded in 168 cases. The major complications associated with CT-guided needle biopsy included pneumothorax (8.33%) and pulmonary hemorrhage (20.24%). Pneumothorax was associated with the lesion size, lesion location, and times of puncture. Pulmonary hemorrhage was associated with the lesion size as well as the pre-operative evaluation of the vascular structures with contrast CT. Chest tube placement was performed in 1 out of 14 cases of pneumothorax. Other cases were not particularly treated. Conclusion The prevention of complications is important for CT-guided needle biopsy. The key factors to prevention the complications include accurate location of the lesions and correct evaluation of the vascular structures before the operation and skillful intraoperative puncture.