CT引导下肺实性结节切割活检术后出血与气胸的多因素分析

摘要

Objective To investigate the risk factors of pneumorrhagia and pneumothorax occurring after CT-guided cutting needle biopsy for pulmonary solid nodules.Methods The clinical data and imaging materials of 320 patients with pulmonary solid nodule (≤3 cm),who received 16 G semi-automatic cutting needle biopsy,were retrospectively analyzed.Both univariate and multivariate logistic regression analysis methods were used to evaluate the risk factors of pneumorrhagia and pneumothorax.Results The incidence of needle track hemorrhage was 33.1％ and the incidence of pneumothorax was 18.1％,the diagnostic accuracy for benign and malignant nodules was 99.6％.Needle track length was an independent risk factor for pneumorrhagia;every increase of 3 cm in needle track length,the risk of pneumorrhagia would increase 3.881 times,besides,the risk of pneumorrhagia had a parallel relationship with the time used for puncturing (P=0.061) as well as with the number of pleural puncturing (P=0.062).The age,lesion's location and needle-pleural angle were independent risk factors for pneumothorax.Each increase of 10 years in age,the risk of pneumothorax would increase 2.102 times.The pneumothorax risk of pulmonary lesion located at upper lung lobe was strikingly lower than that of pulmonary lesion located at lower lung lobe.Each increase of 20 degrees in needle-pleural angle,the risk of pneumothorax would increase 2.413 times.Emphysema was excluded from the equation because it had only a minute difference (P=0.086).Based on the pneumorrhagia and pneumothorax probability values,ROC curves of pneumorrhagia and pneumothorax were drawn,and AUC values of pneumorrhagia and pneumothorax were 0.753 and 0.725 respectively.Conclusion The occurrences of pneumorrhagia and pneumothorax after CT-guided cutting needle biopsy for pulmonary solid nodules are affected by many factors.Careful preoperative evaluation and skilled intraoperative manipulation can effectively reduce the incidence of pneumorrhagia and pneumothorax.%目的 探讨CT引导下经皮穿刺肺实性结节切割活检术后并发出血、气胸的危险因素.方法 回顾性分析肺实性结节(≤3 cm)320例经16 G半自动切割活检的临床及影像学资料,行单因素和多因素Logistic回归分析.结果 活检术后针道出血发生率33.1％,气胸发生率18.1％,良恶性诊断准确率约99.6％.针道长度是出血的独立危险因素,针道每增加3 cm,风险增加3.881倍,且风险也随穿刺时间(P=0.061)和穿胸膜次数(P=0.062)呈正相关.年龄、位置和针-胸膜夹角是气胸独立风险因素,年龄每增加10岁,风险增加2.102倍;上肺叶病灶显著低于下肺叶;针-胸膜夹角每增加20°,风险增加2.413倍,肺气肿以微弱差距(P=0.086)被排除方程之外.以出血、气胸概率值绘制ROC曲线,AUC值分别为0.753和0.725.结论 CT引导下肺实性结节切割活检术后出血、气胸的发生受多种因素影响,术前仔细评估,术中操作熟练度可以有效预判和降低出血、气胸的发生.