多次经支气管镜活检术并发出血及其安全性的分析

Bleeding risk and safety analysis of repeated transbronchial biopsy

摘要:

目的 通过对比分析多次经支气管镜活检术患者每次操作过程中出血程度和并发症发生率的差异，分析多次经支气管镜活检术的安全性。方法 统计接受多次经支气管镜活检术患者的活检次数，并详细对比首次活检及后续活检过程中患者的一般状况、出血情况和并发症发生率的差别。同时分析活检次数、活检获取组织数量和活检部位对活检操作过程中安全性的影响。结果 365例患者共接受778次经支气管镜活检术，严重并发症发生24例次，发生率为3.08%。活检次数对操作过程中并发症发生率无明显影响（P = 0.897），且对严重出血的发生率也无明显影响（P = 0.964）。不同部位活检出血情况的发生率比较，差异无统计学意义（P = 0.125）。其中，严重出血的发生率以右肺中叶最高（5.88%），但各部位比较，差异无统计学意义（P = 0.458）。随着活检中获得组织数量的增多，出血的发生率呈现先降低后升高的变化（获得组织块数量为1块以上，5块以下）。结论 再次经支气管镜活检术仍然是诊断肺部疾病较为安全的检测手段。

Abstract:

Objective To compare the degree of bleeding and the incidence of complications between the first transbronchial biopsy and the follow-up biopsy, and analyze the safety of multiple transbronchial biopsies.Methods The bleeding degree and complication rate of the patients during the first transbronchial biopsy and each follow-up transbronchial biopsy were counted and compared. At the same time, the effects of biopsy times, tissue number and biopsy site on the safety of transbronchial biopsy were analyzed.Results The data of 365 patients included 778 transbronchial biopsies, and showed that there were 24 severe complications occurred, and the overall complication rate was 3.08%. And the number of transbronchial biopsies had no significant difference on the complication rate during operation (P = 0.897) and the incidence of severe bleeding (P = 0.964). There was no significant difference in the bleeding incidence of the different biopsy sites (P = 0.125). The incidence of severe bleeding was the highest in the middle lobe of right lung (5.88%), but there was no significant difference (P = 0.458) when compared with other parts. The results also showed that with the increase of the number of biopsies, the incidence of bleeding decreased firstly and then increased gradually (obtained more than 1 tissue block but less than 5 tissue blocks).Conclusion Transbronchial biopsy is still a safe method for the diagnosis of lung diseases.