CT导引下经皮肺穿刺切割活检术后并发症的相关因素分析

目的:统计CT导引下经皮肺穿刺切割活检(ACNB)术后并发症并分析影响因素。方法:回顾性总结352例胸膜外定位法(EPL)ACNB结果,对主要并发症出血及气胸相关因素行多因素非条件Logistic回归分析。结果:活检准确率为94.9%,每例操作时间为(16.0±2.0)min。出血率22.7%,咯血率5.1%,Logistic分析提示肺不张(OR值0.321)为保护因素。气胸率17.0%,迟发性气胸1.4%,封闭引流率0.6%,Logistic分析提示合并慢性阻塞性肺疾病(COPD)(OR值11.224)及病灶直径(OR值2.556)是气胸发生的危险因素。出血并气胸率6.0%。胸膜反应及术后持续性疼痛各1例。严重并发症率1.4%。结论:CT导引下EPL法ACNB诊断准确率高,出血及气胸是主要并发症,合并肺不张出血率低,合并COPD及病灶直径小气胸率高,要警惕迟发性并发症及严重并发症的发生。

Factors Related to the Complications in CT-Guided Percutaneous Lung Automated Cutting Needle Biopsy

Objective:To evaluate the complication rate of CT-guided percutaneous lung automated core needle biopsies (ACNB) with extrapleural locating method (EPL) and to analyze the impact of multiple factors on the incidence of pulmonary hemorrhage and pneumothorax. Methods:The signs of complication after 352 cases of CT-guided ACNB with EPL were observed and their relationship with multiple factors were analyzed by a multiple logistic regression model. Results:The final diagnostic accuracy was made in 334 cases (94.9%). Mean puncture time was (16.0±2.0) min. Eighty (22.7%) cases presented pulmonary hemorrhage and 18 (5.1%) presented hemoptysis. Single variate analysis showed that the sign of hemorrhage related to lesion diameter,pulmonary atelectasis,length of intrapulmonal biopsy path,and number of pleural needle passes. The multivariate logistic regression analysis showed that pulmonary atelectasis was protective factors (OR=0.321) of pulmonary hemorrhage. Sixty (17.0%) cases presented pneumothorax including 5 cases of later pneumothorax,2 (0.6%) cases required chest tube insertions. Single variate analysis showed that the sign of hemorrhage related to lesion size,chronic obstructive pulmonary disease (COPD),length of intrapulmonal biopsy path,and number of pleural needle passes. The multivariate logistic regression analysis showed that COPD and lesion diameter were risk factors of pneumothorax (OR=11.224,2.556 respectively). One case with pulmonary cryptococcus presented pleural reaction,and one case had the insistent pain. The total number of severe complications was 5 (1.4%) cases. Conclusion:ACNB with EPL is an accurate method for diagnosing pulmonary lesions. Pulmonary atelectasis could reduce bleeding rate. Patients with COPD and smaller lesion diameter significantly increase the risk of pneumothorax. Later and severe complications should be considered during the procedure.