4 150例CT引导下经皮穿刺活检术——并发症分析及防范要点

目的统计和分析大宗病例CT引导下经皮穿刺活检术的并发症，探讨降低严重并发症的措施和护理要点。方法回顾性分析4150例CT引导下经皮穿刺活检术，重点分析3025例肺部穿刺病例中轻度和中、重度并发症的特点。结果4150例中，发生并发症720例（17．35％）：其中轻度628例（15．13％），中度65例（1．57％），重度27例（0．65％）。3025例肺部穿刺的病例中，发生并发症669例（22．12％）；其中轻度579例（19．14％），中度63例（2．08％），重度27例（O．89％）。肺外脏器穿刺的1125例中，发生并发症51例（4．53％）；其中轻度49例（4．36％），中度2例（0．18％）。669例肺部并发症中，单纯气胸、咯血和肺内出血分别占65．32％（437／669）、20．03％（134／669）和9．42％（63／669）。气胸、咯血和肺内出血（包括气胸合并咯血）占肺内总并发症的97．31％（651／669）。发生空气栓塞1例，死亡1例。慢性阻塞性肺部疾病是中重度气胸的主要相关因素：病灶周围血管增多、增粗，穿刺时损伤周围血管和病变内见空气支气管征是严重咯血的主要相关因素。结论cT引导下经皮穿刺活检术是一种较为安全的诊断方法，仔细操作、严密观察及精心护理是预防和减少并发症的重要措施。

4 150 Cases of CT-Guided Percutaneous Needle Biopsy--Analysis of Complications and Nursing Key Points

Objective To analyze the complications of large amount cases of percutaneous needle biopsy guided by computed tomography （CT）, and probe into measures to reduce serious complications and nursing key points. Methods Retrospective analysis of the complications of 4 150 cases on percutaneous needle biopsy guided by CT was performed, including the mild, moderate and severe complications. Among them, 3 025 cases of lung puncture were emphatically analyzed. Results Of the 4 150 cases of CT-guided percutaneous biopsy, complications occurred in 720 cases （17.35%）. Among them, the complications in 628 cases were mild （15.13%）; in 65 cases were moderate （1.57%） and in 27 cases were severe （0.65%）. In 3 025 cases of lung puncture, the complications occurred in 669 cases （22.12%）. Among them, the complications in 579 cases were mild （19.14%）; in 63 cases were moderate （2.08%） and in 27 cases were severe （0.89%）. Of the 1 125 cases of extrapulmonary organs puncture, 51 patients had complications （4.53%）, including mild in 49 cases （4.36%）; moderate in 2 cases （0.18%）. Within the 669 cases of pulmonary complications, the incidences of simple pneumothorax, hemoptysis and pulmonary hemorrhage were respectively 65.32% （437/669）, 20.03% （134/669） and 9.42% （63/669）, accounting for 97.31% of total complications in lung （651/669）. One patient had air embolism and one patient was dead. Chronic obstructive pulmonary disease （COPD） was the main risk factor associated with moderate and severe pneumothorax. Increase and enlargement of surrounding blood vessels and piercing damage of the blood vessels around were the main risk factors associated with severe hemoptysis. In addition, air bronchogram within the lesion was also the risk factor associated with severe hemoptysis. Conclusion CT-guided percutaneous needle biopsy was a safe diagnostic method. Careful operation, strict observation and intensive nursing were important measures to prevent and reduce the postoperation complications.