CT引导下肺穿刺活检术出血与气胸并发症的主要影响因素分析

张广东; 袁牧; 李伍好; 梅琪; 谭玉林

doi:10.16766/j.cnki.issn.1674-4152.001913

CT引导下肺穿刺活检术出血与气胸并发症的主要影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.001913

蚌埠医学院第一附属医院介入科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究项目 KJ2018A1020

蚌埠医学院研究生科研创新计划 Byycxz1992

详细信息

通讯作者:
谭玉林，E-mail：tanyulin2008@163.com

中图分类号: R446.8 R445.3 R563.3
计量
- 文章访问数: 216
- HTML全文浏览量: 75
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2020-09-13
- 网络出版日期: 2022-02-16

Analysis of the main influencing factors of bleeding and pneumothorax complication under CT-guided lung biopsy

Department of Intervention, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨CT引导下肺穿刺活检术的安全性，分析出血、气胸的高危因素，总结降低出血及气胸发生率的操作技巧。方法回顾性分析2018年9月—2020年4月在蚌埠医学院第一附属医院接受CT引导下肺穿刺活检术285例肺占位患者的临床资料，将患者性别、年龄、肿块大小、距胸膜距离、穿刺角度、穿刺深度、穿刺次数、有无肺基础疾病、病灶位置、患者体位等相关因素分为不同分类资料，χ²检验分析各统计资料之间在出血和气胸发生率有无差异性，logistic回归分析出血及气胸的独立危险因素。结果 285例接受CT引导下肺活检穿刺术患者，出血52例(52/285，18.25%)，气胸43例(43/285，15.09%)。单因素检验分析显示术后出血在肿块距离胸膜的距离及穿刺针穿刺深度不同组别之间差异有统计学意义(均P < 0.05)；术后发生气胸在病灶距离胸膜距离、穿刺深度、穿刺次数、肺基础疾病组别之间差异有统计学意义(均P < 0.05)。Logistic回归分析穿刺距离为出血的独立危险因素；肺基础疾病、穿刺次数及穿刺距离是发生气胸的独立危险因素。结论 CT引导下肺活检穿刺安全性高，严重并发症较少，有肺基础疾病、穿刺距离远、穿刺次数多是CT引导下肺穿刺活检术发生出血及气胸的主要危险因素，降低穿刺次数，避开肺大泡、空洞，选择相对较短的穿刺路径可有效降低肺穿刺活检的术后并发症。
- 肺穿刺 /
- 并发症 /
- 气胸 /
- 出血
Abstract: Objective To explore the safety of CT-guided lung biopsy, analyze the high risk factors of bleeding and pneumothorax, and summarize the operational skills to reduce the incidence of bleeding and pneumothorax. Methods The clinical data of 285 patients with lung mass who underwent CT-guided lung biopsy in the first affiliated Hospital of Bengbu Medical College from September 2018 to April 2020 were analyzed retrospectively. The risk factors such as sex, age, tumor size, distance from pleura, puncture angle, puncture depth, puncture times, basic lung disease, lesion location, patient position and other related factors were divided into different grades. Chi-square test was used to analyze whether there were differences in the incidence of bleeding and pneumothorax among statistical data, and logistic regression was used to analyze the independent risk factors of bleeding and pneumothorax. Results CT-guided lung biopsy and puncture: a report of 285 cases, 52 (52/285, 18.25%) had bleeding and 43 (43/285, 15.09%) had pneumothorax. Univariate analysis showed that postoperative bleeding is related to the distance between the mass and the pleura and the depth of puncture needle (all P < 0.05). The occurrence of pneumothorax after surgery was related to factors such as the distance between the lesion and the pleura, the depth of puncture, the number of punctures, and basic lung disease (all P < 0.05). Logistic regression analysis analyzed that the puncture distance was an independent risk factor for bleeding; the basic lung disease, the number of punctures and the puncture distance were independent risk factors for pneumothorax. Conclusion CT-guided lung biopsy is safe and has fewer serious complications. Basic lung diseases, long puncture distance and more puncture times are the main risk factors of bleeding and pneumothorax in CT-guided lung biopsy. Reducing the number of punctures, avoiding pulmonary vesicles and cavities, and choosing a relatively short puncture path can effectively reduce the postoperative complications of lung biopsy.
- Pulmonary puncture /
- Complication /
- Pneumothorax /
- Hemorrhage

HTML全文

图 1 CT引导下右肺肿物穿刺活检术中及术后

注：A为右肺肺门占位，患者取俯卧位穿刺针穿刺到位；B为穿刺活检术后CT复查图像，穿刺道可见出血渗出。

下载: 全尺寸图片幻灯片

图 2 CT引导下左下肺近胸膜处肿物穿刺活检术中及术后

注：A为左侧胸膜下肿物，患者俯卧位穿刺针穿刺到位；B穿刺活检术术后复查CT可见少量气胸。

下载: 全尺寸图片幻灯片

表 1 肺穿刺活检术发生出血与气胸的单因素分析[例(%)]

项目	类别	例数	出血	χ²值	P值	气胸	χ²值	P值
性别	男性	164	36(22.0)	3.556	0.059	26(15.9)	0.177	0.674
	女性	121	16(13.2)			17(14.0)
年龄(岁)	≤65	135	27(20.0)	0.529	0.467	18(13.3)	0.616	0.432
	> 65	150	25(16.7)			25(16.7)
肿块大小(mm)	≤20	80	16(20.0)	0.148^a	0.700	15(18.8)	2.020	0.155
	> 20且≤40	137	24(17.5)			21(15.3)
	> 40	68	12(17.6)			7(10.3)
距胸膜距离(mm)	≤10	109	10(9.2)	26.482^a	< 0.001	27(24.8)	9.721	0.002
	> 10且≤20	110	14(12.7)			10(9.1)
	> 20	66	28(42.4)			6(9.1)
穿刺深度(mm)	≤15	105	2(1.9)	57.413^a	< 0.001	26(24.8)	7.814	0.005
	> 15且≤30	97	12(12.4)			8(8.2)
	> 30	83	38(45.8)			9(10.8)
与肺表面角度(°)	≤45	38	4(10.5)	1.752	0.186	8(21.1)	1.218	0.270
	> 45	247	48(19.4)			35(14.2)
肿块解剖位置	上叶	143	31(21.7)	3.445	0.179	21(14.7)	0.345	0.841
	中叶	18	1(5.6)			2(11.1)
	下叶	124	20(16.1)			20(16.1)
患者体位	仰卧	98	22(22.4)	2.778	0.249	16(16.3)	0.262	0.877
	俯卧	156	27(17.3)			22(14.1)
	侧卧	31	3(9.7)			5(16.4)
穿刺次数(次)	1	275	49(17.8)	0.960	0.397	37(13.5)	16.317	0.001
	≥2	10	3(30.0)			6(60.0)
取材次数(条)	≤2	92	14(15.2)	0.835	0.361	19(20.7)	3.283	0.070
	> 2	193	38(19.7)			24(12.4)
肺基础疾病	有	38	4(10.5)	1.752	0.186	12(31.6)	9.308	0.002
	无	247	48(19.4)			31(12.6)
注：^a为线性趋势χ²值。

下载: 导出CSV

表 2 肺穿刺并发症主要影响因素多因素分析

因变量	自变量	B	SE	Wald χ²	P值	OR(95% CI)
气胸	病灶距离胸膜(1)	-0.886	0.360	6.062	0.014	0.412(0.204~0.835)
	病灶距离胸膜(2)	-0.951	0.578	2.711	0.100	0.386(0.125~1.198)
	穿刺深度(1)	-1.376	0.410	11.243	0.001	0.253(0.113~0.565)
	穿刺深度(2)	-1.242	0.506	6.025	0.014	0.289(0.107~0.779)
	穿刺次数(1)	2.582	0.635	16.515	< 0.001	13.222(3.806~45.928)
	肺基础疾病(1)	0.975	0.396	6.054	0.014	2.651(1.219~5.764)
出血	病灶距离胸膜(1)	-0.080	0.407	0.039	0.843	0.923(0.416~2.048)
	病灶距离胸膜(2)	0.504	0.414	1.482	0.224	1.656(0.735~3.728)
	穿刺深度(1)	1.495	0.587	6.486	0.011	4.458(1.411~14.085)
	穿刺深度(2)	3.144	0.578	29.576	< 0.001	23.195(7.470~72.024)
注：各变量赋值方法如下, 气胸，是=1，否=0；出血，是=1，否=0；病灶与胸膜距离≤10 mm=0， > 10 mm且≤20 mm=1， > 20 mm=2；穿刺深度，≤15 mm=0， > 15 mm且≤30 mm=1， > 30 mm=2；穿刺次数，1次=0，≥2次=1；肺基础疾病，无=0，有=1。

下载: 导出CSV

参考文献(17)

[1]	ZHENG R, ZENG H, ZHANG S, et al. National estimates of cancer prevalence in China, 2011[J]. Cancer Lett, 2016, 370(1): 33-38. doi: 10.1016/j.canlet.2015.10.003
[2]	辛雯艳, 黄磊, 闫贻忠. 2005-2013年中国肿瘤登记地区肺癌流行和疾病负担时间趋势分析[J]. 中华肿瘤防治杂志, 2019, 26(15): 1059-1065. https://www.cnki.com.cn/Article/CJFDTOTAL-QLZL201915001.htm
[3]	ANDRADE J R, ROCHA R D, FALSARELLA P M, et al. CT-guided percutaneous core needle biopsy of pulmonary nodules smaller than 2 cm: technical aspects and factors influencing accuracy[J]. J Bras Pneumol, 2018, 44(4): 307-314. doi: 10.1590/s1806-37562017000000259
[4]	赵成岭, 李伟, 陈余清, 等. CT引导下经皮肺穿刺对肺亚实性结节病变的诊断价值及安全性评价[J]. 中华全科医学, 2018, 16(8): 1241-1243. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201808005.htm
[5]	YAN GW, BHETUWAL A, YAN GW, et al. A systematic review and meta-analysis of c-arm cone-beam ct-guided percutaneous transthoracic needle biopsy of lung nodules[J]. Pol J Radiol, 2017, 19(82): 152-160. http://ruj.uj.edu.pl/xmlui/bitstream/handle/item/39611/yan_bhetuwal_yan_sun_niu_zhou_li_li_zeng_zhang_li_xu_yang_du_a_systematic_review_and_meta-analysis_of_c-arm_cone-beam_2017.pdf?sequence=1&isAllowed=y
[6]	罗海亮, 顾禄寿, 罗好曾, 等. 低剂量螺旋CT在肺癌门诊机会性筛查中的应用[J]. 中国肿瘤, 2017, 26(3): 185-189. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHLU201703006.htm
[7]	任丽娜, 刘春芳, 徐健, 等. 超声支气管镜引导下支气管针吸活检在肺癌及纵隔肺门病变诊断中的应用价值[J]. 中国肿瘤临床与康复, 2016, 23(1): 63-65. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK201601025.htm
[8]	王晓平, 陈利军, 万毅新, 等. 393例肺癌患者的电子支气管镜检查结果分析[J]. 中国生物制品学杂志, 2016, 29(2): 175-180. https://www.cnki.com.cn/Article/CJFDTOTAL-SWZP201602016.htm
[9]	LIM W H, PARK C M, YOON S H, et al. Time-dependent analysis of incidence, risk factors and clinical significance of pneumothorax after percutaneous lung biopsy[J]. Eur Radiol, 2018, 28(3): 1328-1337. doi: 10.1007/s00330-017-5058-7
[10]	严高武, 杨国庆, 付泉水, 等. CT引导下肺穿刺活检诊断肺部局灶性磨玻璃密度结节失败因素分析[J]. 川北医学院学报, 2017, 32(5): 684-687. doi: 10.3969/j.issn.1005-3697.2017.05.010
[11]	NOUR-ELDIN N E, ALSUBHI M, EMAM A, et al. Pneumothorax complicating coaxial and non-coaxial ct-guided lung biopsy: comparative analysis of determining risk factors and management of pneumothorax in a retrospective review of 650 patients[J]. Cardiovasc Intervent Radiol, 2016, 39(2): 261-270. doi: 10.1007/s00270-015-1167-3
[12]	胡富天, 黄大钡, 李晓群, 等. C臂CT引导肺穿刺活检术并发症的危险因素分析[J]. 介入放射学杂志, 2019, 28(1): 49-53. doi: 10.3969/j.issn.1008-794X.2019.01.010
[13]	张皓, 杨茂江, 琼仙, 等. 多层螺旋CT引导下经皮肺穿刺活检术的临床应用及并发症影响因素分析[J]. 华西医学, 2017, 32(8): 1238-1242. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX201708021.htm
[14]	MORELAND A, NOVOGRODSKY E, BRODY L, et al. Pneumothorax with prolonged chest tube requirement after CT-guided percutaneous lung biopsy: incidence and risk factors[J]. Eur Radiol, 2016, 26(10): 3483-3491. doi: 10.1007/s00330-015-4200-7
[15]	李显敏, 余娴, 胡伟, 等. CT引导下经皮肺穿刺并发症发生率及影响因素[J]. 中国老年学杂志, 2016, 36(18): 4560-4562. doi: 10.3969/j.issn.1005-9202.2016.18.079
[16]	纪翠敏, 赵英华, 夏良绪. CT引导下经皮肺穿刺活检术后并发出血的原因及护理策略[J]. 中国医刊, 2019, 54(9): 976-979. doi: 10.3969/j.issn.1008-1070.2019.09.016
[17]	张重明. CT引导下经皮肺穿刺活检术后发生肺出血的因素分析[J]. 中国介入影像与治疗学, 2018, 15(4): 209-212. https://www.cnki.com.cn/Article/CJFDTOTAL-JRYX201804005.htm