CT引导下经皮肺穿刺活检术后发生肺出血的因素分析

摘要

目的 观察CT引导下经皮肺穿刺活检术后发生肺出血的危险因素.方法 选取347例接受CT引导下经皮肺穿刺活检术患者,对病历资料及术中CT图像进行回顾,分析可能引起肺出血的临床因素,患者因素包括年龄、性别、是否合并肺气肿、主肺动脉直径、是否服用抗血小板药物;手术及病变因素包括穿刺次数、进针角度、病变最大径、形态及病变与胸膜间距离.结果 347例中,168例术后发生肺出血(出血组),其中咯血25例,1例发生血气胸.术后出血组女性比例(P＝0.010)、合并肺气肿比率(P＝0.016)、亚实性病变比率(P＝0.036)均高于未出血组,病灶最大径(P＝0.003)、胸膜下病变比率(P＜0.001)均较未出血组低.主肺动脉直径增宽(≥2.9 cm)患者与未增宽患者间术后肺出血发生率差异无统计学意义(x2＝0.011,P＝0.915).结论 CT引导下经皮肺穿刺活检术后发生肺出血常见,但较少需要临床干预.CT测量主肺动脉直径增宽不是术后发生肺出血的危险因素.%Objective To explore the risk factors of pulmonary hemorrhage in patients undergoing CT-guided percutaneous lung biopsy.Methods Data of 347 patients who underwent CT-guided percutaneous lung biopsy were retrospectively reviewed.Clinical factors that might cause pulmonary hemorrhage,including age,gender,whether combine with emphysema,main pulmonary artery diameter,and whether or not taking antiplatelet drugs,puncture frequency,needle angle,maximum diameter,morphology,as well as the distance between lesion and pleural were analyzed.Results Among 347 patients,168 patients developed pulmonary hemorrhage after the procedures (hemorrhage group),including 25 patients with hemoptyses and 1 patient with hemopneumothorax.Compared with non hemorrhage group,ratio of female (P＝0.010),of emphysema (P＝0.016) and of sub-solid lesions (P＝0.036) were higher in hemorrhage group,while lesions' diameter was smaller (P＝0.003) and ratio of subpleural lesions was lower (P＜0.001) in hemorrhage group.The difference of pulmonary hemorrhage ratio between patients with enlarged main pulmonary artery diameter at CT (≥2.9 cm) or not had no statistical significance (x2 ＝ 0.011,P＝ 0.915).Conclusion Pulmonary hemorrhage after CT-guided percutaneous lung biopsy is common but rarely need clinical treatment.Enlarged main pulmonary artery diameter at CT (≥2.9 cm) is not the risk factor of pulmonary hemorrhage after puncture.