经皮影像引导下肝活检术后出血并发症的预测因素：一项范围综述
Predictors of bleeding complications following percutaneous image-guided liver biopsy: a scoping review.
作者信息
Midia Mehran, Odedra Devang, Shuster Anatoly, Midia Ramin, Muir Jeffrey
机构信息
Department of Radiology, McMaster University School of Medicine, Hamilton, ON, Canada.
Department of Radiology, Thunder Bay Health Sciences, Thunder Bay, ON, Canada.
出版信息
Diagn Interv Radiol. 2019 Jan;25(1):71-80. doi: 10.5152/dir.2018.17525.
PURPOSE
Percutaneous tissue biopsy is a mainstay of diagnostic and interventional radiology, providing a minimally invasive method for diagnosing malignant and benign disease. The purpose of this review was to collect and summarize the best available evidence regarding the risk factors associated with bleeding complications in image-guided liver biopsy.
METHODS
A literature review was performed, searching Medline, EMBASE, CINAHL, the Cochrane Library, the National Institute for Health and Care Excellence (NICE) and Canadian Agency for Drugs and Technology in Health (CADTH) databases for any studies evaluating bleeding complications in image-guided liver biopsy. A total of 68 articles, published between January 1994 and April 2015, were reviewed in full, with 34 ultimately eligible for inclusion in the review.
RESULTS
Bleeding of any kind occurred in up to 10.9% of image-guided liver biopsies, with major bleeding episodes ranging from 0.1% to 4.6% and minor bleeding events occurring in up to 10.9% of biopsies. The overall rate of bleeding was, however, found to be less than 2%. Several risk factors (patient, operator, and procedure-related) were identified as potentially indicative of an increased risk of post-biopsy bleeding. Patient-related risk factors included patient age (>50 years or <2 years), inpatient status (8/12 vs. 4/12, P < 0.001), comorbidities and/or concurrent diagnoses and coagulation status (rate of bleeding was 3.3% for international normalized ratio [INR] 1.2-1.5 vs. 7.1% for INR >1.5, P < 0.001). There was no consensus on impact of operator experience (>200 biopsies/year vs. <50/year) on post-biopsy bleeding rate. Procedure-related risk factors included needle size (cutting biopsy vs. fine needle aspiration, P < 0.001) and the presence of a patent track on post-biopsy ultrasound (P < 0.001). Lastly there was no difference found between targeted vs. nontargeted biopsies and number of needle passes.
CONCLUSION
Reported rate of post-biopsy bleeding ranges between 0% and 10.9%, although the vast majority of studies reported bleeding rates under 2%. Several patient, operator, and procedure-related risk factors are associated with a higher risk of bleeding following liver biopsy.
目的
经皮组织活检是诊断性和介入性放射学的主要手段，为诊断恶性和良性疾病提供了一种微创方法。本综述的目的是收集并总结关于影像引导下肝活检出血并发症相关危险因素的最佳现有证据。
方法
进行了一项文献综述，检索了Medline、EMBASE、CINAHL、Cochrane图书馆、英国国家卫生与临床优化研究所（NICE）和加拿大卫生技术评估署（CADTH）数据库，以查找评估影像引导下肝活检出血并发症的任何研究。共对1994年1月至2015年4月发表的68篇文章进行了全文审查，最终有34篇符合纳入本综述的标准。
结果
在影像引导下的肝活检中，高达10.9%的病例发生了任何类型的出血，严重出血事件发生率为0.1%至4.6%，轻微出血事件发生率高达10.9%。然而，总体出血率被发现低于2%。确定了几个危险因素（与患者、操作者和操作过程相关）可能表明活检后出血风险增加。与患者相关的危险因素包括患者年龄（>50岁或<2岁）、住院状态（8/12 vs. 4/12，P<0.001）、合并症和/或同时诊断以及凝血状态（国际标准化比值[INR]为1.2 - 1.5时出血率为3.3%，而INR>1.5时为7.1%，P<0.001）。关于操作者经验（每年>200次活检 vs. <50次/年）对活检后出血率的影响尚无共识。与操作过程相关的危险因素包括针的大小（切割活检与细针穿刺，P<0.001）以及活检后超声检查时是否存在穿刺通道（P<0.001）。最后，靶向活检与非靶向活检以及穿刺针数之间未发现差异。
结论
报道的活检后出血率在0%至10.9%之间，尽管绝大多数研究报道的出血率低于2%。几个与患者、操作者和操作过程相关的危险因素与肝活检后出血风险较高相关。
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