CT引导下经皮肺穿刺活检并发出血的预防和处理

目的探讨CT引导下经皮肺穿刺活检并发出血的预防和处理。方法回顾性分析558例接受CT引导下经皮肺穿刺活检的患者资料,分析穿刺活检并发肺出血的程度、相关因素、止血方法。结果558例中,96例并发肺出血(96/558,17.20%),其中少量出血72例(72/558,12.90%),中等量出血21例(21/558,3.76%),大量出血3例(3/558,0.54%)。与肺出血相关的危险因素包括病灶直径、位置、血供情况、病灶周围炎症、病理诊断及穿刺深度(P均0.05)。对少量及中等量出血患者局部注射凝血酶或置入明胶海绵颗粒,对大量出血者静脉注射凝血酶或特利加压素并严格卧床,均获得较好止血效果。结论 CT引导下经皮肺穿刺活检并发出血可预防、可处理,术前增强CT检查并排除技术上可避免的相关因素有助于减低出血的发生率。

Preventation and treatment of pulmonary hemorrhage complicating CT-guided percutaneous lung biopsy

Objective To explore the prevention and treatment of pulmonary hemorrhage complicating CT-guided percutaneous lung biopsy. Methods A retrospective analysis of 558 patients with lung lesion who underwent CT-guided percutaneous lung biopsy was performed. Extent and underlying factors associated with development of pulmonary hemorrhage as well as hemostasis were analyzed. Results There were 96 patients with pulmonary hemorrhage (96/558, 17.20%), including 72 cases of mild hemorrhage (72/558, 12.90%), 21 cases of moderate hemorrhage (21/558, 3.76%) and 3 cases of serious hemorrhage (3/558, 0.54%). Significant risk factors associated with hemorrhage included diameter, location, blood supply of pulmonary lesion, existence of around inflammatory lesions, pathologic diagnosis and needle track distance traversing the lung parenchyma (all P<0.05). Locally injecting reptilase or inserting gelatinsponge particles was necessary to cure mild and moderate bleeding. For the treatment of serious hemorrhage, it was effective to execute intravenous infusion reptilase or Terlipressin and strictly bed rest. Conclusion Hemorrhage complicating CT-guided percutaneous lung biopsy can mainly be preventable and curable. Preoperative enhanced CT scan and exclusion of technically avoidable risk factors are helpful to reduce incidence of hemorrhage.