概述

骨髓活检和骨髓穿刺用于收集和检查骨髓(一些较大骨骼中的海绵状组织)。

骨髓活检和骨髓穿刺可以显示骨髓是否健康,造血细胞是否正常。医生通过这些手术诊断并监测血液和骨髓疾病(包括一些癌症),以及不明病因的发热情况。

骨髓包括液态部分和固态部分。在骨髓活检中,医生会用针抽取固态部分的样本。在骨髓穿刺时,医生会用针抽取液态部分的样本。

骨髓活检和骨髓穿刺通常是同时进行的。这些手术可以统称为骨髓检查。

目的

骨髓活检和骨髓穿刺可提供有关骨髓和血细胞状况的详细信息。

如果血液检测异常或未能提供有关可疑问题的足够信息,医生可能会安排进行骨髓检查。

医生可能会进行骨髓检查以:

  • 诊断涉及骨髓或血细胞的疾病或健康问题
  • 确定疾病的阶段或进展
  • 检查铁水平和新陈代谢
  • 监测疾病的治疗情况
  • 调查不明原因的发热

骨髓活检和穿刺可用于许多健康问题。包括:

  • 贫血
  • 某些类型的血细胞产生过少或过多的血细胞问题,例如白细胞减少症、白细胞增多症、血小板减少症、血小板增多症、全血细胞减少症和红细胞增多症
  • 血液或骨髓癌症,包括白血病、淋巴瘤和多发性骨髓瘤
  • 从另一部位(例如乳腺)扩散到骨髓的癌症
  • 血色素沉着症
  • 不明原因的发热

骨髓活检和骨髓穿刺可提供有关骨髓细胞的不同但互补的信息。这两种医疗操作通常一起执行。

风险

骨髓检查通常能够安全进行。其并发症很少见,但可能出现:

  • 大出血,特别是某种血细胞(血小板)数量较少的患者
  • 感染,特别是免疫系统较弱的患者
  • 活检部位长期不适
  • 在胸骨穿刺过程中刺穿胸骨,可能导致心脏或肺部问题

如何进行准备

骨髓检查通常在门诊进行。通常不需要特殊准备。但是,您可能需要:

  • 告诉医生您正在服用的药物和补充剂。某些药物和补充剂可能会增加骨髓活检和穿刺后出血的风险。
  • 如果您对该程序感到紧张,请告诉医生。和医生讨论一下您对检查的担忧。在某些情况下,医生可能会在检查前给您注射镇静剂,此外,还会在针头插入的部位注射麻醉剂(局部麻醉)。

可能出现的情况

可以在医院、诊所或医生诊室进行骨髓活检和穿刺。

通常由专门从事血液疾病(血液学家)或癌症(肿瘤学家)的医生完成。

骨髓检查通常需要大约 10 分钟。事先准备和术后护理需要额外的时间,特别是如果您要接受静脉(IV)镇静。该手术的总时间约为 30 分钟。

术前

将检查您的血压和心率,并会给您某种形式的麻醉以使您感到舒适。

大多数人只需要局部麻醉,因为骨髓穿刺尤其会引起短暂但剧烈的疼痛。手术过程中您将完全清醒,但是将进行抽吸和活检部位麻醉以减轻疼痛。

如果您害怕疼痛,可能会给您静脉注射药物,以便在骨髓检查期间完全或部分注射镇静剂。

医生将插入活检针的区域将被标记并清洁。骨髓液(抽吸物)和组织样本(活检)通常从髋骨后(髂后嵴)采集。有时,可能会使用髋关节的前部。

有时从胸骨或小腿骨(对于 12 至 18 个月以下的儿童)采集骨髓穿刺物,但活检样本不会从这个位置采集。

您需要俯卧或侧卧,然后将为您盖上手术服,仅漏出检查部位。

骨髓穿刺

通常首先进行骨髓穿刺。医生会切一个小口,然后将一根空心针穿过骨头并插入骨髓。

医生使用连接在针头上的注射器取出骨髓体液部分的样品。您可能会感到短暂的剧烈疼痛或刺痛。抽吸仅需几分钟。可能会采集几个样本。

医护团队会检查样本以确保其足够。极少数情况下,如果无法抽出体液,则需要移动针头再次尝试。

骨髓活检

医生会使用较大的针头抽取固体骨髓组织样本。活检针经专门设计,用来从骨髓中采取圆柱形核心样本。

术后

将会按压插入针头的区域以止血。然后用绷带包扎。

如果您进行了局部麻醉,则将要求您仰卧 10 至 15 分钟,并将按压活检部位。然后您便可以离开并开始自己的生活,只要感觉良好就可以恢复正常活动。

如果您进行过静脉镇静,您将被带到康复区。找人开车送您回家,并休息 24 小时。

骨髓检查后一个星期或更长时间,您可能会感到有些压痛。询问医生是否要服用止痛药,例如对乙酰氨基酚(Tylenol 等等)。

部位护理

戴上绷带并在 24 小时内不要沾水。不要淋浴、沐浴、游泳或使用热水浴缸。24 小时后抽吸和活检区域才能沾水。

如果出现以下情况,请联系您的医生:

  • 出血渗入绷带或无法通过直接按压来止血
  • 持久发热
  • 疼痛或不适加剧
  • 手术部位肿胀
  • 手术部位红肿或积液的情况加剧

为了最大程度地减少出血和不适,请在一两天内避免剧烈运动或锻炼。

Before the procedure

Your blood pressure and heart rate will be checked, and you'll be given some form of anesthesia to keep you comfortable.

A bone marrow examination can be done with only local anesthesia to numb the area where the needles will be inserted. With local anesthesia, bone marrow aspiration, in particular, can cause brief, but sharp, pain. Many people choose to also have light sedation for additional pain relief.

If you're anxious about pain, you may be given an IV medication so that you're either completely or partially sedated during the bone marrow exam.

The area where the biopsy needles will be inserted is marked and cleaned with an antiseptic. The bone marrow fluid (aspirate) and tissue sample (biopsy) are usually collected from the top ridge of the back of a hipbone (posterior iliac crest). Sometimes, the front of the hip may be used.

You'll be asked to lie on your abdomen or side, and your body will be draped with cloth so that only the exam site is showing.

Rarely, bone marrow aspiration — but not biopsy — is collected from the breastbone or, in children under the age of 12 to 18 months, from the lower leg bone.

Bone marrow aspiration

The bone marrow aspiration is usually done first. The doctor or nurse makes a small incision in the skin, then inserts a hollow needle through the bone and into the bone marrow.

Using a syringe attached to the needle, a sample of the liquid portion of the bone marrow is withdrawn. You may feel a brief sharp pain or stinging. The aspiration takes only a few minutes. Several samples may be taken.

The health care team checks the sample to make sure it's adequate. Rarely, fluid can't be withdrawn and the needle is moved for another attempt.

Bone marrow biopsy

The doctor or nurse uses a larger needle to withdraw a sample of solid bone marrow tissue. The biopsy needle is specially designed to collect a core (cylindrical sample) of bone marrow.

After the procedure

Pressure will be applied to the area where the needle was inserted to stop the bleeding. Then a bandage will be placed on the site.

If you had local anesthesia, you'll be asked to lie on your back for 10 to 15 minutes and apply pressure to the biopsy site. You can then leave and go about your day, returning to normal activity as soon as you feel up to it.

If you had IV sedation, you'll be taken to a recovery area. Plan to have someone drive you home, and take it easy for 24 hours.

You may feel some tenderness for a week or more after your bone marrow exam. Ask your doctor about taking a pain reliever, such as acetaminophen (Tylenol, others).

Site care

Wear the bandage and keep it dry for 24 hours. Don't shower, bathe, swim or use a hot tub. After 24 hours you can get the area wet.

Contact your doctor if you have:

  • Bleeding that soaks through the bandage or doesn't stop with direct pressure
  • A persistent fever
  • Worsening pain or discomfort
  • Swelling at the procedure site
  • Increasing redness or drainage at the procedure site

To help minimize bleeding and discomfort, avoid rigorous activity or exercise for a day or two.

结果

骨髓样本将送到实验室进行分析。您的医生通常会在几天内告知您结果,但也可能需要更长的时间。

在实验室,血液学家或活检分析专家(病理学家)将评估样本,以确定您的骨髓是否产生了足够的健康血细胞,并寻找异常细胞。这些信息可以帮助您的医生:

  • 确认或排除诊断
  • 确定疾病的进展程度
  • 评估治疗是否有效

根据您的检查结果,您可能需要后续的检查。

临床试验

探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法,旨在预防、检测、治疗或控制这种疾病。

July 03, 2022
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  2. Zehnder JL. Bone marrow aspiration and biopsy: Indications and technique. http://www.uptodate.com/home. Accessed Sept. 18, 2014.
  3. AskMayoExpert. What are the indications for a bone marrow aspiration and biopsy? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
  4. Pfenninger JL, et al. Pfenninger and Fowler's Procedures for Primary Care. 3rd ed. Philadelphia, Pa.: Mosby Elsevier; 2011. https://www.clinicalkey.com. Accessed Sept. 18, 2014.
  5. Hortholm N, et al. Strategies of pain reduction during the bone marrow biopsy. Annals of Hematology. 2013;92:145.

骨髓活检和穿刺