颅内病变立体定向活检出血的相关因素分析

The related factors of stereotactic biopsy bleeding of intracranial lesions

目的探讨颅内病变立体定向活检出血的相关因素。方法回顾性总结2012年1月至2017年11月间我科收治行MRI导向立体定向活检并有阳性病例结果的99例病例。患者年龄11~81岁,平均50.16岁;其中男54例,女45例;病灶位于额叶10例,颞叶3例,顶枕叶9例,基底节区及丘脑51例,鞍区3例,三角部8例,松果体区2例,多发性病灶13例。所有患者均采用Leksell-G型定向仪经3.0T磁共振扫描,所有靶点活检均采用单针道Sedan侧方开口活检针,所有入选病例经病理证实阳性结果。根据术后有无临床症状分为症状性出血和非症状性出血,根据出血发生时间分为急性出血(小于24h)和迟发性出血(大于24h)。结果活检部位发生出血率为13.13%(13例),其中无症状性出血10.10%(10例),症状性出血3.03%(3例);恶性胶质瘤占69.23%(9例),淋巴瘤23.08%(3例),其他7.69%(1例);基底节及丘脑占61.54%(8例),其他38.46%(例);急性出血占92.31%(12例),迟发性出血占7.69%(1例)。结论颅内病变立体定向活检部位出血具有一定发病率,其中大多为无症状性的急性发病,而基底节区及丘脑部位的恶性胶质瘤、淋巴瘤成为活检出血的重要危险因素。

Objective To investigate related factors of stereotactic biopsy bleeding of intracranial lesions.Methods 99 patients underwent MRI-guided stereotactic biopsy were analyzed retrospectively from January 2012 to November 2017.The patients were aged between 11-81（mean 50.16）years,including 54 males and 45 females.The lesions were located in frontal lobe in 10 cases,temporal lobe in 3 cases,parietal occipital lobe in 9 cases,basal ganglia and thalumus in 51 cases,sellar area 3 cases,triangular part 8 cases,pineal region 2 cases,multiple lesions 2 cases.All patients were examined by Leksell-G system and 3.0-Tesla magnetic resonance system.All biopsies were performed by single Sedan side-cutting needle.All specimens were confirmed by pathology.According to the time and clinical symptoms of postoperative bleeding,they were divided into symptomatic bleeding and non symptomatic bleeding,and acute bleeding（less than 24 h）and delayed bleeding（greater than 24 h）.Results The postoperative bleeding rate of biopsy sites was 13.13%（13 cases）,including 10.10% asymptomatic hemorrhage（10 cases）and3.03% symptomatic hemorrhage（3 cases）,malignant glioma accounted for 69.23%（9 cases）,23.08%lymphoma（3 cases）,the other 7.69%（1 cases）,basal ganglia and thalamus（accounted for 61.54% 8）,the other 38.46%cases（cases）,acute hemorrhage accounted for 92.31%（12 cases）,delayed hemorrhage accounted for 7.69%（1 cases）.Conclusion There is a certain incidence of bleeding in stereotactic biopsy for intracranial lesions,most of which are asymptomatic acute onset.However,malignant glioma and lymphoma in basal ganglia and thalamus become an important risk factor for biopsy bleeding.