肝脏占位性病变经皮穿刺活检术出血并发症的危险因素分析  

Analysis of risk factors for bleeding complications in percutaneous needle biopsy of liver space-occupying lesions

作　　者：程芝梅 王黎洲[1] 何慧洲 魏子敬 李雪莹 周石[1] CHENG Zhimei;WANG Lizhou;HE Huizhou;WEI Zijing;LI Xueying;ZHOU Shi(School of Medical Imaging,Guizhou Medical University,Guiyang,Guizhou Province 550004,China)

机构地区：[1]贵州医科大学影像学院,贵阳550004

出　　处：《介入放射学杂志》2021年第11期1162-1165,共4页Journal of Interventional Radiology

基　　金：国家自然科学基金(81860320、81960328)。

摘　　要：目的寻找影像引导肝脏原发或继发占位性病变经皮穿刺活检术后发生出血并发症的危险因素。方法回顾性分析2015年1月至2020年7月515例肝脏占位性病变行超声或CT引导穿刺活检患者的临床资料。将术后出现腹腔或肝包膜下出血作为因变量,将患者性别、年龄、病变类型、病理结果、肿瘤大小、位置、是否位于肝包膜下、有无肝硬化、穿刺引导方式、穿刺组织条数、穿刺深度、术前血小板、凝血酶原时间国际标准化比值(INR)及血红蛋白作为自变量,所有自变量行单因素logistic回归分析,将P<0.05自变量行多因素logistic回归分析,筛选肝脏占位性病变经皮穿刺活检术出血并发症的危险因素。结果共纳入453例肝脏占位性病变行穿刺活检的患者,术后发生腹腔或肝包膜下出血者19例(4.2%)。单因素logistic回归分析显示肝硬化、穿刺组织条数及穿刺深度与术后发生出血有关。多因素logistic回归分析显示肝硬化与穿刺深度为出血并发症的危险因素(P<0.05)。受试者工作特征(ROC)曲线预测肝硬化患者穿刺活检术后发生出血并发症的敏感性为32%,特异性为97.9%。结论肝硬化及穿刺深度是肝脏占位性病变经皮穿刺活检术出血并发症的危险因素。Objective To discuss the risk factors for bleeding complications in imaging-guided percutaneous needle biopsy of primary or secondary hepatic space-occupying lesions.Methods The clinical data of a total of 515 patients with liver space-occupying lesions,who received ultrasound-guided or CT-guided percutaneous biopsy between January 2015 and July 2020,were retrospectively analyzed.The postoperative bleeding in the abdominal cavity or hepatic capsule were taken as the dependent variables,and the patient’s gender,age,lesion type,pathological results,tumor size,location,whether located under the liver capsule,presence or absence of cirrhosis,guiding method for puncturing,number of obtained puncture tissue strips,puncturing depth,preoperative platelets count and International Normalized Ratio(INR)of prothrombin time and hemoglobin level were used as the independent variables.Univariate logistic regression analysis was used for all independent variables,and the variables with a P<0.05 were included in the regression model and were analyzed by multivariate logistic regression analysis,and the risk factors for bleeding complications after percutaneous biopsy of liver space-occupying lesions were screened out.Results A total of 453 patients with liver space-occupying lesions,who received imaging-guided percutaneous liver biopsy,were enrolled in this study.Nineteen patients(4.2%)developed postoperative bleeding in the abdominal cavity or hepatic capsule.Univariate logistic regression analysis indicated that cirrhosis,the number of obtained puncture tissue strips and puncturing depth were related to postoperative bleeding.Multivariate logistic regression analysis revealed that cirrhosis and puncturing depth were the risk factors for bleeding complications(P<0.05).The sensitivity and specificity of receiver operating characteristic(ROC)curve in predicting bleeding complications after needle biopsy were 32%and 97.9%respectively.Conclusion Cirrhosis and puncturing depth are risk factors for bleeding complications in imaging-

关 键 词：经皮穿刺活检术 危险因素 出血 

分 类 号：R816[医药卫生—放射医学]