Kane N M, Korobkin M, Francis I R, Quint L E, Cascade P N
Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109-0326.
AJR Am J Roentgenol. 1991 Oct;157(4):777-80. doi: 10.2214/ajr.157.4.1892034.
Acute pancreatitis is an unusual but recognized complication of percutaneous aspiration biopsy of the pancreas. As the pancreatic tail is located anterior to the left adrenal gland, percutaneous biopsy of a left adrenal mass via the anterior approach may result in needle passage through the tail of the pancreas with subsequent potential development of pancreatitis. To evaluate this risk, we retrospectively reviewed 48 CT-directed percutaneous aspiration biopsies of left adrenal masses done between 1984 and 1989 at two institutions. Positioning of the patient, the course of the needle, the number of needle passes, and the size of the needle were analyzed. Thirty-three (69%) of 48 biopsies of a left adrenal mass were performed by using the anterior approach. The pancreas was traversed by one or more needles in 32 of 33 cases. Biopsies were performed with 20- to 22-gauge needles, and the number of needle passes varied widely. The medical records of the 33 patients in whom the anterior approach was used also were reviewed for complications. Acute pancreatitis, which required 11-13 days of hospitalization, developed in two patients (6%). None of the other 31 patients suffered a complication. We conclude that the pancreatic tail is routinely traversed by the biopsy needle when biopsy of a left adrenal mass is done via the anterior approach and that severe acute pancreatitis can occur as a result.
急性胰腺炎是胰腺经皮穿刺活检一种罕见但已被认识到的并发症。由于胰尾位于左肾上腺前方，经前路对左肾上腺肿块进行经皮活检可能导致穿刺针穿过胰尾，随后有发生胰腺炎的潜在风险。为评估这一风险，我们回顾性分析了1984年至1989年间在两家机构进行的48例CT引导下左肾上腺肿块经皮穿刺活检病例。分析了患者体位、穿刺针路径、穿刺针次数及穿刺针规格。48例左肾上腺肿块活检中，33例（69%）采用前路穿刺。33例中有32例穿刺针穿过了胰腺。活检使用的穿刺针规格为20至22号，穿刺针次数差异很大。我们还查阅了采用前路穿刺的33例患者的病历以了解并发症情况。两名患者（6%）发生了急性胰腺炎，需要住院11至13天。其他31例患者均未出现并发症。我们得出结论，经前路对左肾上腺肿块进行活检时，穿刺针通常会穿过胰尾，可能会导致严重的急性胰腺炎。
