鞍区、松果体及脑干病灶立体定向活检并发症临床研究

Clinical study on the safety of stereotactic biopsy of the sella,pineal and brain stem lesions

目的总结鞍区、松果体及脑干部位立体定向活检的并发症并进行分析,以进一步提高活检的安全性。方法回顾分析我科2015年1月～2017年12月期间鞍区、松果体及脑干部位活检的病例,对出血率、死亡率等手术并发症进行统计,并分析可能的原因。结果共完成鞍区、松果体区及脑干三个中线部位活检病例145例,其中鞍区、松果体区及脑干部位病变分别为16例(11.03%)、18例(12.41%)、111例(76.55%),活检阳性率分别为16/16(100%)、18/18(100%)、107/111(96.39%)。活检术中及术后出现各种并发症17例(15.32%),均为脑干活检病例,其中死亡3例(2.7%)。主要临床表现为面神经麻痹、面部疼痛、血压及心率改变、呼吸困难等。结论鞍区、松果体区及脑干部位立体定向活检术总体具有较高的阳性率和安全性,并发症发生情况与这些部位的解剖和功能特点有关。

Objective To investigate the safety of stereotactic biopsy(SB)of sellar region,pineal region and brainstem,and to further improve the safety of SB.Methods A retrospective analysis was carried out in our department during January 2015~ December 2017.All the cases who received SB of sellar region,pineal region and brainstem were enrolled and analyzed about the operative complications such as bleeding rate,mortality and possible reasons.Results A total of145 cases with lesion of sellar region,pineal region and brainstem were enrolled.The number were16 cases(11.03%),18 cases(12.41%)and 111 cases(76.55%)for sellar region,pineal region and brainstem.The positive rate of biopsy was 16/16(100%),18/18(100%)and 107/111(96.39%)respectively.There were 17 cases(15.32%)of complications in brainstem during or after SB,of which 3 cases died.The main clinical manifestations were facial nerve paralysis,facial pain,change of blood pressure and/or heart rate,and dyspnea.Conclusion SB in sellar region,pineal region and brainstem area has a high positive rate and safety.The occurrence of complications is related to the anatomical and functional characteristics of these parts.