超声引导经皮穿刺肝组织活检肝脏内出血的影像学表现及处理措施

Imaging and therapeutic measures for liver hemorrhage caused by liver biopsy under untrasound guiding

目的探讨超声引导经皮穿刺肝组织活检引起肝内出血的影像学表现,分析出血原因并提出相应的处理方法。方法回顾分析8例肝内出血患者的影像学表现、出血原因及处理方法。结果 8例肝内出血患者,4例腹腔内见不同深度的游离无回声区,4例腹腔内未见游离无回声区;6例CT检查示肝内出血部位为高低密度混合灶,包膜下及肝脾周围可见带状低回声。3例患者行DSA检查,其中2例表现为密度减低区(动静脉瘘),1例表现为多发活动性出血灶。5例患者行保守治疗,自行止血,2例患者行单纯动脉栓塞止血,1例患者行动脉栓塞后6h开腹止血。结论肝内出血的超声表现较典型,结合病史可准确诊断。同时应将特殊类型的肝硬化及特发性门脉高压列为相对禁忌症,提示临床在适当时机及时进行介入和手术止血。

Objective To evaluate ultrasound-guided liver biopsy cause bleeding in liver imaging findings,analyze the causes of bleeding and the corresponding treatment. Methods Retrospective analysis of 8 cases of bleeding in patients with liver imaging manifestations,causes and treatment of bleeding. Results 8 cases of liver hemorrhage,4 cases of intraperitoneal showed the different depths of free anechoic area,four cases of free intraperitoneal no echo-free zone;six cases CT examination revealed liver bleeding is high density mixed lesions,subcapsular and hypoechoic band seen around the liver and spleen. DSA examination performed on 3 cases,2 cases showed lower density region （arteriovenous fistula）,one case showed multiple foci of active bleeding. 5 cases treated conservatively,self-bleeding,2 cases with simple arterial embolization,1 case underwent laparotomy 6 h after embolization hemostasis. Conclusion Intrahepatic bleeding more typical sonographic appearance,combined with a history can be accurately diagnosed. But also indicate that the particular type of liver cirrhosis and idiopathic portal hypertension as a relative contraindication,suggesting that at the appropriate time timely clinical intervention and surgery to stop bleeding.