经典文献：CT引导下肺穿刺的风险
CT引导下肺穿刺一般是安全的，并且基本都能取到外周病灶，成功率高，病人一般也比较舒适。
但是，肩胛骨挡住的病灶，靠近中央血管的病灶，不宜选择此方法。今天和大家分享一篇经典文献，随时可能会用到！
Tomiyama N, Yasuhara Y, Nakajima Y, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol. 2006 Jul;59(1):60-4. doi: 10.1016/j.ejrad.2006.02.001. Epub 2006 Mar 10. PMID: 16530369.
国外报道9783例次肺穿刺活检术
气胸发生率35%。
严重并发症的发生率0.75%。
空气栓塞的发生率为万分之6.1 。
穿刺引起肿瘤种植转移的发生率为万分之6.1 。
严重的张力性气胸的发生率是千分之一。
严重的大出血的发生率为万分之6.1 。
血胸的发生率为万分之9.2 。
其他严重并发症（包括心脏骤停、休克、呼吸停止）的发生率是千分之2.6 。
死亡率是万分之七。
我感觉死亡率比支气管镜高！支气管镜死亡率一般没有万分之七。
原始文献
Purpose: The aim of our study was to update the rate of severe complications following CT-guided needle biopsy in Japan via a mailed survey.
目的：调查日本CT引导下穿刺活检术后严重并发症的发生率。
Materials and methods: Postal questionnaires regarding CT-guided needle biopsy were sent out to multiple hospitals in Japan. The questions regarded: the total number and duration of CT-guided lung biopsies performed at each hospital, and the complication rates and numbers of pneumothorax, hemothorax, air embolism, tumor seeding, tension pneumothorax and other rare complications. Each severe complication was followed with additional questions.
材料和方法：向日本多家医院发送有关CT引导下穿刺活检的邮寄问卷。调查内容：各医院CT引导下肺活检的总数和持续时间，以及气胸、血胸、空气栓塞、肿瘤种植、张力性气胸和其他罕见并发症的发生率和数量。每一个严重的并发症都有额外问卷。
Results: Data from 9783 biopsies was collected from 124 centers. Pneumothorax was the most common complication, and occurred in 2412 (35%) of 6881 cases. A total of 39 (35%) hospitals reported 74 (0.75%) cases with severe complications. There were six cases (0.061%) with air embolism, six cases (0.061%) with tumor seeding at the site of the biopsy route, 10 cases (0.10%) with tension pneumothorax, six cases (0.061%) with severe pulmonary hemorrhage or hemoptysis, nine cases (0.092%) with hemothorax, and 27 cases (0.26%) with others, including heart arrest, shock, and respiratory arrest. From a total of 62 patients with severe complications, 54 patients (0.55%) recovered without sequela, however one patient (0.01%) recovered with hemiplegia due to cerebral infarction, and the remaining seven patients (0.07%) died.
结果：共收集124个中心9783例活检资料。最常见的并发症是气胸，6881例中发生气胸2412例（35%）。39家（35%）医院报告严重并发症74例（0.75%）。其中空气栓塞6例（0.061%），活检部位肿瘤种植6例（0.061%），张力性气胸10例（0.10%），严重肺出血或咯血6例（0.061%），血胸9例（0.092%），其他27例（0.26%），包括心脏骤停、休克，呼吸停止。62例严重并发症中，54例（0.55%）无后遗症，1例（0.01%）因脑梗死偏瘫恢复，其余7例（0.07%）死亡。
Conclusions: This is the first national study documenting severe complications with respect to CT-guided needle biopsy in Japan. The complication rate in Japan is comparable to internationally published figures. We believe this data will improve both clinicians as well as patients understanding of the risk versus benefit of CT-guided needle biopsy, resulting better decisions.
结论：这是日本首例记录CT引导下穿刺活检严重并发症的全国性研究。日本的并发症发生率与国际公布的数字相当。我们相信这些数据将提高临床医生和患者对CT引导下穿刺活检的风险和益处的理解，从而做出更好的决定。
哎
理解万岁！
听老医生说，我们之前遇到1例，肺穿刺后数分钟，病人突然死亡。我觉得可能是空气栓塞。
没有最好的办法，只有相对好一点的办法！
今晚给一个大咯血的病人做支气管镜取堵住支气管的血块，幸好很顺利，支气管镜之前病人氧饱和度88%，做完支气管镜取出大部分血凝块，氧饱和度升至95%~100%。病人才30多岁，希望他平安。家属是农村来的，看着是老好人。要是家属各种犹豫不决、各种指责签字、各种莫名其妙的怀疑医生，我真的是不知道肿么办。
视频
你说生男孩好还是生女孩好，这下明白了吧？
陈翔六点半：你还记得最初的梦想吗？