2026 年第 9 期 第 21 卷

CT引导下经皮肝实质活检术后脓毒症1例报道并文献复习

Sepsis following CT-guided percutaneous liver parenchymal biopsy: a case report and literature review

作者：徐若欣张俊丽  

英文作者：Xu Ruoxin Zhang Junli

单位：浙江大学医学院附属邵逸夫医院肝病感染科，杭州310000

英文单位：Department of Hepatology and Infectious Diseases Sir Run Run Shaw Hospital Zhejiang University School of Medicine Hangzhou 310000 China

关键词：肝穿刺活检；脓毒症；胆肠吻合术；胆管炎；胆源性肝损伤

英文关键词：Liverbiopsy;Sepsis;Hepaticojejunostomy;Cholangitis;Biliaryliverinjury

• 摘要：

• 经皮肝穿刺活检在肝脏疾病的诊断、治疗及预后评估中具有重要作用，肝穿刺活检后并发脓毒症是临床极为少见的并发症。本文报道1例基础Roux-en-Y胆肠吻合术病史，术后出现不明原因肝功能异常，影像学提示肝实质炎症，经CT引导下经皮肝穿刺活检后发生脓毒症，血培养大肠埃希菌，术后肝穿刺活检病理提示胆源性感染的临床病例。胆肠吻合术后因解剖结构改变、吻合口狭窄、胆汁反流及肠道细菌逆行定植等因素，肝脏穿刺操作后易诱发脓毒症。因此对于此类具有潜在胆道感染风险的患者，在行肝穿刺活检前应充分评估，必要时考虑预防性使用抗菌药物，以降低脓毒症发生率。

• Percutaneous liver biopsy plays a vital role in the diagnosis, treatment and prognostic evaluation of liver diseases, while sepsis after liver biopsy is an extremely rare clinical complication. This article reports a clinical case of a patient with a history of Roux-en-Y hepaticojejunostomy, who developed unexplained abnormal liver function after surgery with imaging evidence of hepatic parenchymal inflammation, and suffered from sepsis after CT-guided percutaneous liver biopsy. Blood culture yielded Escherichia coli, and postoperative pathological examination of liver biopsy indicated biliary tract infection. Due to anatomical changes, anastomotic stricture, bile reflux and retrograde colonization of intestinal bacteria after hepaticojejunostomy, liver puncture is prone to induce sepsis. Therefore, full evaluation should be performed before liver biopsy for patients with potential risk of biliary tract infection, and prophylactic antibiotics should be administered when necessary to reduce the incidence of sepsis.