Mueller P R, Miketic L M, Simeone J F, Silverman S G, Saini S, Wittenberg J, Hahn P F, Steiner E, Forman B H
Department of Radiology, Massachusetts General Hospital, Boston 02114.
AJR Am J Roentgenol. 1988 Sep;151(3):493-4. doi: 10.2214/ajr.151.3.493.
A retrospective review of 184 pancreatic biopsies in 178 patients was performed to assess the prevalence of severe postbiopsy pancreatitis. The size, contour, and pathology of the lesions biopsied; the course of the needle (i.e., through bowel or other viscera); the size of the needle; the number of needle passes made; and the guidance technique used were analyzed. Severe pancreatitis developed in five cases (five patients) 5/184 or 3% of the biopsies), usually within 24-48 hr. Three of the five patients who developed pancreatitis had true-negative biopsies (normal pancreas) proved either at surgery (two) or at clinical follow-up (one). The diagnoses for the two remaining patients were adenocarcinomas. In four of the five patients, the diagnosis of severe pancreatitis was made by inspection at surgery. The fifth case was diagnosed by CT. Three patients who underwent surgery and one patient who had percutaneous drainage recovered from the pancreatitis. The fifth patient died despite surgical intervention. All five patients with pancreatitis had masses 3 cm or smaller as compared with the overall group, in which 71 (39%) of the 184 biopsies performed had masses smaller than 3 cm. Overall, 18% of the biopsies were true negative, compared with the 60% true-negative rate in the pancreatitis group. The bowel was transgressed in 21% of all 178 patients, including three of the five pancreatitis patients. We conclude that although the risk of pancreatitis is exceedingly small in percutaneous needle biopsies, it may occur, and at a higher rate than previously reported.
对178例患者的184次胰腺活检进行回顾性研究，以评估活检后严重胰腺炎的发生率。分析了活检病变的大小、轮廓和病理；穿刺针的行径（即是否穿过肠道或其他内脏）；穿刺针的大小；穿刺针的穿刺次数；以及所采用的引导技术。5例患者（5次活检，占184次活检的5/184或3%）发生了严重胰腺炎，通常在24 - 48小时内。发生胰腺炎的5例患者中，有3例活检结果为真阴性（胰腺正常），这在手术时（2例）或临床随访时（1例）得到证实。其余2例患者的诊断为腺癌。5例患者中有4例在手术时通过检查诊断为严重胰腺炎。第5例通过CT诊断。3例接受手术的患者和1例接受经皮引流的患者胰腺炎康复。第5例患者尽管接受了手术干预仍死亡。与总体组相比，所有5例胰腺炎患者均有3cm或更小的肿块，在184次活检中，有71例（39%）肿块小于3cm。总体而言，18%的活检结果为真阴性，而胰腺炎组的真阴性率为60%。在所有178例患者中，21%的患者穿刺针穿过了肠道，其中包括5例胰腺炎患者中的3例。我们得出结论，尽管经皮穿刺活检后胰腺炎的风险极小，但仍可能发生，且发生率高于先前报道。
