CT引导下经皮胸部穿刺活检术的临床应用及并发症防治分析

发布时间：2018-01-21 23:52

本文关键词： 胸部穿刺活检　出处：《石河子大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的在肯定CT引导下经皮胸部穿刺活检术临床应用价值的基础上观察其术中术后相关并发症，分析产生并发症的原因和主要影响因素，并提出有效的防治方法，讨论如何进一步提高CT引导下经皮胸部穿刺活检术穿刺成功率。方法回顾性分析石河子大学医学院第一附属医院放射科自2005年06月至2012年06月间191例具有完整影像资料的在美国GE多排螺旋CT引导下采用18G弹簧式活检针进行的经皮胸部穿刺活检术病例。统计191例CT引导下经皮胸部穿刺活检术的穿刺成功率和相关并发症发生率。结果 191例经皮胸部穿刺活检术均穿刺成功，，穿刺成功率100%。其中气胸出现46例，发生率为24%，其中少量气胸45例(肺组织压缩小于30％)。病房观察2小时，未做特殊处理，数日后自行吸收； 1例肺组织压缩大于30％，及时行胸腔穿刺抽气术后，症状减轻、好转，未做其它特殊处理，临床观察数日后自行吸收。肺出血51例，发生率为27%，其中46例并发少量出血，未作特殊临床处理。 5例并发中量出血临床均表现为大咯血数口，行口服止血药物治疗，临床观察2-3天后咯血停止。皮下气肿1例。结论 1.CT引导下经皮胸部穿刺活检术定位准确，标本采集成功率高；2.CT引导下经皮胸部穿刺活检术最常见的并发症为气胸、出血；3.影响并发症发生的主要因素包括肺气肿因素、穿刺病灶的大小、病灶距离胸壁的深度、肺内穿刺的次数；4.进一步提高CT导引下经皮胸部穿刺活检术穿刺成功率、减少并发症的主要措施包括：严格的病例选择原则；适当的CT扫描体位；严谨的CT扫描定位要求；精确的穿刺点和穿刺通道选择原则（非常关键）；操作者娴熟地掌握穿刺技巧；有效的标本采集原则；患者控制每次呼吸幅度和闭气程度的能力；并发症的积极预防，准确判断与有效处理。
[Abstract]:Purpose On the basis of confirming the clinical application value of percutaneous thoracic biopsy guided by CT, the related complications during and after operation were observed, the causes and main influencing factors of complications were analyzed, and the effective prevention and treatment methods were put forward. Discussion on how to further improve CT guided percutaneous chest The success rate of biopsy was successful. Method Retrospective analysis of 191 cases with complete imaging data collected under GE multi-slice spiral CT guidance from June 2005 to June 2012 in Department of Radiology, first affiliated Hospital, School of Medicine, Shihezi University. The successful rate of percutaneous thoracic biopsy and the incidence of related complications were analyzed in 191 cases of CT guided percutaneous thoracic biopsy with 18G spring biopsy needle. Results The successful rate of puncture was 100. 46 cases of pneumothorax occurred, the incidence rate was 24%. A small amount of pneumothorax was found in 45 cases (lung tissue compression was less than 30%). The room was observed for 2 hours without special treatment and absorbed by itself a few days later. The lung tissue compression was more than 30 in one case, the symptom was alleviated, improved, no other special treatment was done, and the pulmonary hemorrhage occurred in 51 cases (27%). Among them, 46 cases were complicated with a small amount of bleeding, without special clinical treatment. The clinical manifestations of 5 cases with moderate hemorrhage were massive hemoptysis, which were treated with oral hemostatic drugs. The hemoptysis stopped in 2 to 3 days after clinical observation, and 1 case suffered from subcutaneous emphysema. Conclusion 1. Ct guided percutaneous puncture biopsy was accurate, and the success rate of specimen collection was high. 2. The most common complication of CT guided percutaneous thoracic biopsy was pneumothorax and hemorrhage. 3. The main factors affecting complications included emphysema, the size of the puncture focus, the depth of the lesion from the chest wall, and the number of punctures in the lung. 4. To further improve the successful rate of percutaneous thoracic biopsy under CT guidance, the main measures to reduce complications include: strict principle of case selection; Proper CT scanning posture; Strict CT scanning localization requirements; Accurate puncture point and puncture passage selection principle (very important); The operator mastered the puncture skill skillfully; Effective principles of specimen collection; The ability of the patient to control the breath amplitude and the degree of atresia; Positive prevention, accurate judgment and effective treatment of complications.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R655;R816.4

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