本文關(guān)鍵詞： 胸部 穿刺 活檢　出處：《石河子大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 在肯定CT引導(dǎo)下經(jīng)皮胸部穿刺活檢術(shù)臨床應(yīng)用價值的基礎(chǔ)上觀察其術(shù)中術(shù)后相關(guān)并發(fā)癥，分析產(chǎn)生并發(fā)癥的原因和主要影響因素，并提出有效的防治方法，討論如何進(jìn)一步提高CT引導(dǎo)下經(jīng)皮胸 部穿刺活檢術(shù)穿刺成功率。 方法 回顧性分析石河子大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院放射科自2005年06月至2012年06月間191例具有完整影像資料的在美國GE多排螺旋CT引導(dǎo)下采用18G彈簧式活檢針進(jìn)行的經(jīng)皮胸部穿刺活檢術(shù)病例。統(tǒng)計191例CT引導(dǎo)下經(jīng)皮胸部穿刺活檢術(shù)的穿刺成功率和相關(guān)并發(fā)癥發(fā)生率。 結(jié)果 191例經(jīng)皮胸部穿刺活檢術(shù)均穿刺成功，，穿刺成功率100%。其中氣胸出現(xiàn)46例，發(fā)生率為24%，其中少量氣胸45例(肺組織壓縮小于30％)。病房觀察2小時，未做特殊處理，數(shù)日后自行吸收； 1例肺組織壓縮大于30％，及時行胸腔穿刺抽氣術(shù)后，癥狀減輕、好轉(zhuǎn)，未做其它特殊處理，臨床觀察數(shù)日后自行吸收。肺出血51例，發(fā)生率為27%，其中46例并發(fā)少量出血，未作特殊臨床處理。 5例并發(fā)中量出血臨床均表現(xiàn)為大咯血數(shù)口，行口服止血藥物治療，臨床觀察2-3天后咯血停止。皮下氣腫1例。 結(jié)論 1.CT引導(dǎo)下經(jīng)皮胸部穿刺活檢術(shù)定位準(zhǔn)確，標(biāo)本采集成功率高；2.CT引導(dǎo)下經(jīng)皮胸部穿刺活檢術(shù)最常見的并發(fā)癥為氣胸、出血；3.影響并發(fā)癥發(fā)生的主要因素包括肺氣腫因素、穿刺病灶的大小、病灶距離胸壁的深度、肺內(nèi)穿刺的次數(shù)；4.進(jìn)一步提高CT導(dǎo)引下經(jīng)皮胸部穿刺活檢術(shù)穿刺成功率、減少并發(fā)癥的主要措施包括：嚴(yán)格的病例選擇原則；適當(dāng)?shù)腃T掃描體位；嚴(yán)謹(jǐn)?shù)腃T掃描定位要求；精確的穿刺點(diǎn)和穿刺通道選擇原則（非常關(guān)鍵）；操作者嫻熟地掌握穿刺技巧；有效的標(biāo)本采集原則；患者控制每次呼吸幅度和閉氣程度的能力；并發(fā)癥的積極預(yù)防，準(zhǔn)確判斷與有效處理。
[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.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R655;R816.4

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