CT 引导下肺病灶共轴针吸活检

肺病灶针吸活检最常见的并发症是气胸,还可引起肿瘤细胞的种植。为克服这些并发症,本文介绍了一种改良的针吸活检技术,即在CT 引导下应用一个共轴针(Coaxial needle)行针吸活检。30例预行肺病灶共轴针吸活检病人先行胸部CT检查,以确定病灶部位及进针点,同时了解纵隔情况.进针部位常规消毒,1%利多卡因局麻后用16号针对病灶部位垂直刺入,直至针尖接近胸膜。在针管内     

阻塞性肺疾患病人行经皮针吸活检时不增加气胸发生的危险性

气胸是经皮针吸肺活检最多见的并发症,好发因素包括病灶大小及部位、术者的熟练程度、胸膜穿刺次数、患者年龄以及存在阻塞性肺疾患。本文复习了1987～1991年间CT引导下行经皮针吸肺活检患者的临床资料、肺功能试验、胸片及CT表现。 方法 116例疑为肺癌患者均在CT引导下行经皮针吸肺活检,先做CT及胸片检查确定病灶大小(二维)及部位(外周性或中心性)。术后对患者活检部位行CT及胸片检查,并发气胸者,CT及胸片均可查见。临床医师根据患者情况确定是否安置胸导管。 116例患者中有93例行肺功能测定有效。对此93     

CT引导下经皮肺穿刺活检并发症的相关因素研究

目的 探讨CT引导下经皮肺穿刺活检发生并发症的相关因素.方法 选取我院行CT引导下经肺穿刺活检的60例患者作为研究对象,探讨穿刺后并发症的发生情况,并探讨其与患者性别、年龄、病灶大小、病灶与胸壁的深度、病灶部位的关系.结果 1.通过对穿刺后并发症发生情况进行分析发现,60例患者中,共24例患者出现并发症,并发症发生率为40%;2.观察组（合并并发症）患者中穿刺后病灶＜2 cm、病灶距离胸膜的距离≥2 cm、病灶部位位于肺下叶者发生穿刺后并发症的比例大于对照组（未合并并发症）,差异具有统计学意义（P＜0.05）.结论 CT引导下经皮肺穿刺活检容易出现气胸、肺出血、感染、胸膜休克等并发症,主要与病灶位置、深度、大小等因素有关.     

CT引导下经皮肺活检术的临床应用价值及安全性分析

目的 探讨CT引导下经皮肺活检术的临床应用价值及安全性.方法 93例患者在CT引导下经皮肺活检术,分析影响临床诊断正确率及肺活检术并发症的因素.结果 93例患者中有90例得到明确的病理学诊断,临床诊断正确率为96.67%.病灶离胸膜距离≤5 cm和＞5 cm的肺出血发生率分别是1.67%和12.12%,差异有统计学意义.结论 CT引导下经皮肺活检术诊断正确率高,并发症以气胸和肺出血为主,肺出血发生率随病灶离胸膜距离的增加而增高,其安全性较高.     

CT引导下经皮肺活检气胸的发生率及其危险因素

目的 探讨使用精细针在CT引导下经皮肺活检气胸发生率及相关危险因素.方法 收集158例在CT引导下使用精细针经皮肺活检患者,回顾性分析患者年龄、性别、病灶直径、穿刺针经过肺组织深度和患者肺通气功能与气胸发生的关系.结果 共发生气胸28例,发生率为17.7%.年龄＞60岁、病灶直径≤3 cm、穿刺针经过肺组织深度≥1 cm、一秒钟用力呼气容积%(FEV1%)≤70%的患者气胸发生率均显著升高(P均＜0.05).结论 患者年龄大、病灶直径小、穿刺针经过肺组织增加、FEV1%的降低增加了CT引导下经皮肺活检时发生气胸的危险.     

老年患者肺内病变CT引导下穿刺活检的应用分析

目的探讨老年人群肺内病变CT引导下穿刺活检的价值和安全分析。方法回顾总结177例行CT引导下肺内病变穿刺活检的老年患者,作出定性临床诊断。结果CT引导下穿刺活检病理诊断总正确率为92．7％,诊断正确率的影响因素为病灶大小和病灶内部性质。并发症发生率为24．3％,并发症发生率的影响因素为气促分级、病灶胸膜距、穿刺次数、病变大小、灶周肺气肿,而与活检体位和胸壁厚度无相关统计学意义。结论CT引导下穿刺活检可以作为老年患者肺内病变的一种安全、准确、高效的诊断方法。并发症发生率与病灶大小呈负相关,与气促分级、病灶胸膜距、穿刺次数、病变大小、灶周肺气肿呈正相关。     

CT引导下经皮肺穿刺活检诊断肺占位病灶分析

目的分析应用切割穿刺针行CT引导下经皮肺穿刺活检的诊断价值及安伞性。方法选取124例行CT引导下肺穿刺活检的患者,总结CT引导下肺穿刺活检确诊率、并发症发生率及并发症与年龄、性别、病灶大小、病灶部位、是否伴有COPD的关系。结果CT引导下肺穿刺活检的患者中,癌症确诊率83．9％,病灶定性确诊率92．7％。发生气胸15例（12．1％）,咯血12例（9．8％）。讨论CT引导下肺穿刺活检是一种可行的诊断方法。并发症中气胸发生率与病灶部位及是否伴有COPD有明显关系,与年龄、性别、病灶大小无关,咯血发生率与各因素之间均无关。     

CT引导经皮肺穿刺活检术在肺部肿物中的临床应用

目的探讨CT引导经皮肺穿刺活检术对肺部肿物的诊断价值。方法采用CT引导经皮肺穿刺活检术197例肺部肿物进行穿刺活检,病灶直径2～10 cm（平均4.2 cm）,病灶距胸膜深度0～8cm（平均3.4 cm）。结果诊断恶性病变133例,良性病变（炎症、结核、结节病）54例,诊断率94.9%（187/197）,病理不能确诊10例,其中6例手术确诊为肺鳞癌,4例随访2年无变化。术后并发症气胸28例,胸腔出血2例,咯血6例。结论 CT引导经皮肺活检术是一种安全、诊断率高的诊断方法,尤其适用于距离胸膜较近病灶。     

体位补偿法提高中老年肺占位病人的经皮肺穿刺活检成功率

目的探讨体位补偿法在中老年肺占位病人中CT引导下经皮肺穿刺活检的优势。方法回顾性分析了我院从2015年1月至2017年10月期间收治的44例肺占位病人,采用体位补偿法进行CT引导下经皮肺穿刺活检术获取组织,对病理结果、气胸以及出血发生率进行分析。结果 44例(100%)病人均获得明确的病理结果,43例(97.7%)病人能很好配合肺穿刺操作,取材过程顺利,标本满意,不良反应发生率低。发生轻度气胸11例(25.0%),中度气胸2例(4.5%),轻度出血7例(15.9%),无感染、种植转移、死亡等严重不良事件发生。结论采用体位补偿法可安全准确地对中老年肺癌病人的病灶进行穿刺活检。     

CT引导下经皮肺穿刺并发气胸的影响因素分析

目的分析CT引导下经皮肺穿刺并发气胸的概率及影响因素。方法回顾2013年8月至2018年1月呼吸科行CT引导下经皮肺穿刺术的所有患者,按是否并发气胸分为两组,统计分析两组的临床资料。结果共210例,男性148例、女性62例,年龄63(55,71)岁;病灶直径3.1(2,4.7)cm,CT值35(24,46)Hu;病灶外缘离穿刺点距离1.05(0.2,2.3)cm;术后病理学诊断为肺恶性肿瘤71%、炎性病变29%。并发气胸者47例(22.4%),肺压缩最大面积约80%,1例合并皮下气肿,均治疗后康复,时间1-5天。卡方分析示,肺部病灶密度不均、病灶外缘离穿刺点距离大于、等于3cm或伴有肺气肿、肺大疱的患者,术后气胸发生率较高(P0.05),气胸与性别等其他因素无明显关联;Logistic回归显示,病灶密度不均、病灶外缘离穿刺点距离大于等于3cm、存在肺气肿、肺大疱,为术后并发气胸的危险因素(P0.05),相对危险度(OR)分别为6.264、2.971、8.444。结论气胸是CT引导下经皮肺穿刺的常见并发症;病灶密度不均、病灶外缘离穿刺点距离大于等于3cm或存在肺气肿、肺大疱的患者,术后气胸的发生率显著增高。     

Management of pneumothorax after percutaneous CT-guided lung biopsy

OBJECTIVES: To evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and to avoid chest tube placement in cases of pneumothorax following CT-guided lung biopsy. DESIGN: Observational. MATERIALS AND METHODS: One hundred thirty-four consecutive percutaneous needle lung biopsies using real-time CT fluoroscopy guidance formed the basis of our study. All patients that demonstrated moderate or severe pneumothorax on postbiopsy chest CT images underwent percutaneous manual aspiration regardless of symptoms while on the CT scanner table. Correlation between the incidence of pneumothorax after biopsy and many factors (i.e., gender, age, number of pleural passes, presence of emphysema, lesion size, and lesion depth) were determined, and management of each case of biopsy-induced pneumothorax was reviewed. RESULTS: Postbiopsy pneumothorax occurred in 46 of 134 procedures (34.3%). Twenty of the 46 patients were treated by manual aspiration, while 26 patients were simply observed. In 43 of the 46 pneumothoraces (93.5%), the pneumothorax resolved completely on follow-up chest radiographs without requiring tube placement. Only three patients (2.2% of the entire series; 6.5% of those who had pneumothorax develop) required chest tube placement. The risk of pneumothorax significantly increased with lesion size and depth. CONCLUSION: Results of our nonprospective, nonrandomized study suggest that percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent progressive pneumothorax and subsequent chest tube placement.     

Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies

BACKGROUND: The results of studies identifying the risk factors for pneumothorax and bleeding in CT-guided coaxial lung needle biopsies were inconsistent and some were even contradictory. All reported series were small with patient populations averaging about 200. STUDY OBJECTIVES: To determine the risk factors for pneumothorax and bleeding after CT-guided coaxial cutting needle biopsy of lung lesions. DESIGN: Retrospective analysis. METHODS: We reviewed 660 biopsy procedures. The risk factors for pneumothorax and bleeding were determined by multivariate analysis of variables related to patient demographics, lung lesions, biopsy procedures, and the individual radiologist. RESULTS: The main complications were pneumothorax (23%; 155 of 660 procedures), chest tube insertion (1%; 9 of 660 procedures), and hemoptysis (4%; 26 of 660 procedures), with no patient mortality. The highest pneumothorax rate correlated with a lesion size of /= 2.1 cm, and the absence of pleural effusion. CONCLUSIONS: The risk factors for highest pneumothorax rate are lesion size /= 2.1 cm, and lung lesions not associated with a pleural effusion.     

经皮穿刺肺活检术并发症的防治进展

经皮穿刺肺活检诊断肺部病变尤其是肺外周结节／肿块性疾病创伤小、诊断率高,其主要并发症包括气胸和出血,空气栓塞、皮下气肿、肺内感染播散以及穿刺针道恶性肿瘤种植等并发症少见。大多数并发症无需特殊处理,气胸量较大或者症状明显时可以置管引流,出血量较大者可以输血以及对症治疗,空气栓塞较重时行高压氧治疗。活检针直径较大、吸烟、病变胸膜距离远、多次穿刺活检和操作时间长等是发生并发症的危险因素。     

Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung

STUDY OBJECTIVES: To evaluate the incidence and clinical significance of delayed pneumothorax, and to analyze the influence of multiple variables on the rate of delayed pneumothorax associated with transthoracic needle biopsy (TTNB) of the lung. STUDY DESIGN: Prospective study. SETTING: Tertiary care university hospital. STUDY SUBJECTS: Adult patients underwent TTNB from June 2001 to June 2002. MEASUREMENTS AND RESULTS: Among the 458 patients included in this study, 280 fluoroscopic-guided, 21 CT-guided, and 157 ultrasonography-guided lung biopsies were performed. A follow-up chest radiograph was obtained immediately, and 3 h, 8 h, and 24 h after the biopsy procedure. Pneumothorax that had not developed up to 3 h but developed later was defined as a delayed pneumothorax. Patients with a symptomatic or enlarged pneumothorax were treated using a pigtail catheter or chest tube. Variables such as age, gender, lesion size, location, presence of an emphysematous change, biopsy guidance methods, and biopsy devices were analyzed. Pneumothorax developed in 100 of the 458 patients (21.8%), and delayed pneumothorax developed in 15 patients (3.3%). Seventeen patients, including 3 patients with delayed pneumothorax, required a pigtail catheter or a chest tube insertion. The pigtail catheter or chest tube insertion rate in delayed pneumothorax was 20% (3 of 15 patients). Female gender and the absence of an emphysematous change correlated with an increased rate of delayed pneumothorax (p < 0.05). Lesion size, location, biopsy guidance methods, devices, and underlying diseases were not correlated with the delayed pneumothorax rate. CONCLUSIONS: The incidence of delayed pneumothorax was 3.3% of all TTNBs. Female gender and the absence of an emphysematous change were identified as risk factors for delayed pneumothorax. Delayed pneumothorax is clinically important because of its considerable incidence and the necessity for pigtail catheterization or chest tube insertion in these patients.     

CT引导下经皮肺穿刺活检并发症的发生因素

目的 探讨分析CT引导下肺穿刺活检中对并发症的发生的影响因素.方法 选取自2009年1月~2011年12月进行 CT引导下肺穿刺活检患者174例,于术后观察患者并发症发生情况.结果 全部患者行CT引导下肺穿刺活检成功.穿刺后出现气胸28例（16.1%）;肺出血37例（21.3%）,含针道少许出血29例（16.7%）;咯血9例（5.17%）;皮下气肿3例（1.72%）;血胸1例（0.57%）.年龄、穿刺次数、穿刺时间、病灶大小、穿刺深度与并发症的发生率有显著的联系（P＜0.05）.结论 CT引导下经皮进行肺穿刺活检是临床肺部病理检查的一种安全有效的方法.     

CT引导下肺穿刺活检的安全性分析

目的：分析应用切割穿刺针行CT引导下肺穿刺活检的安全性。方法：选取连续的290例行CT引导下肺穿刺活检患者。回顾性总结CT引导下肺穿刺活检的并发症及其发生率与穿刺部位，穿刺针直径，穿刺针所经肺组织深度之间的关系。结果：290例行CT引导下肺穿刺活检的患者中，发生少量气胸69例（23．8％），中等量气胸11例（3．8％），肺内出血46例（15．9％），皮下气肿1例（0．3％），咯血2例（0．7％），胸腔出血2例（0．7％），经统计学分析，穿刺针所经肺组织深度不同的病例组之间，穿刺活检并发症的发生率的差异有显著性；穿刺针对经肺组织深度相同的病例中，不同部位之间穿刺活检的并发症的发生率的差异无显著性。结论：CT引导下肺穿刺活检是一种可行的诊断方法。CT引导下肺穿刺活检并发症发生率以气胸和肺内出血为多见，发生多与病变所在部位关系不大，而随穿刺 针经过肺组织的深度的增深而增高。     

A Retrospective Multi-Site Academic Center Analysis of Pneumothorax and Associated Risk Factors after CT-Guided Percutaneous Lung Biopsy

Purpose

To assess the risk factors, incidence and significance of pneumothorax in patients undergoing CT-guided lung biopsy.

Methods

Patients who underwent a CT-guided lung biopsy between August 10, 2010 and September 19, 2016 were retrospectively identified. Imaging was assessed for immediate and delayed pneumothorax. Records were reviewed for presence of risk factors and the frequency of complications requiring chest tube placement. 604 patients were identified. Patients who underwent chest wall biopsy (39) or had incomplete data (9) were excluded.

Results

Of 556 patients (average age 66 years, 50.2% women) 26.3% (146/556) had an immediate pneumothorax and 2.7% (15/556) required chest tube placement. 297/410 patients without pneumothorax had a delayed chest X-ray. Pneumothorax developed in 1% (3/297); one patient required chest tube placement. Pneumothorax risk was associated with smaller lesion sizes (OR 0.998; 95% CI (0.997, 0.999); [p = 0.002]) and longer intrapulmonary needle traversal (OR 1.055; 95% CI (1.033, 1.077); [p < 0.001]). Previous ipsilateral lung surgery (OR 0.12; 95% CI (0.031, 0.468); [p = 0.002]) and longer needle traversal through subcutaneous tissue (OR 0.976; 95% CI (0.96, 0.992); [p = 0.0034]) were protective of pneumothorax. History of lung cancer, biopsy technique, and smoking history were not significantly associated with pneumothorax risk.

Conclusion

Delayed pneumothorax after CT-guided lung biopsy is rare, developing in 1% of our cohort. Pneumothorax is associated with smaller lesion size and longer intrapulmonary needle traversal. Previous ipsilateral lung surgery and longer needle traversal through subcutaneous tissues are protective of pneumothorax. Stratifying patients based on pneumothorax risk may safely obviate standard post-biopsy delayed chest radiographs.

     

CT引导下经皮肺切割活检在不同肺部病变中的临床应用

目的探讨CT引导下经皮肺切割活检在不同肺部病变中的应用价值。方法对65例肺部病变行CT引导下经皮肺切割活检。结果此法诊断恶性病变的敏感性为85.3%,特异性为100%,准确性为91.1%。并发气胸12.3%,咯血9.2%。结论此法在不同的肺部病变中均可有较高的准确性,安全可靠。     

Biopsy site selection for endobronchial ultrasound guide-sheath transbronchial biopsy of peripheral lung lesions

Background: Choice of biopsy method for peripheral lung lesions is usually between CT-guided fine-needle aspiration biopsy (CT FNA) and bronchoscopy. Endobronchial ultrasound guide-sheath biopsy (EBUS GS) is a new method to improve the yield of bronchoscopy. Guidance on which lesions would be appropriate for either method is needed. The aim of the study was to compare the diagnostic yields and pneumothorax rate of EBUS GS and CT FNA in terms of the location of the lesion needing biopsy, in particular, whether the lesion is touching the pleura.
Methods: Prospective series of EBUS GS were compared to retrospective review of CT FNA carried out simultaneously in a large teaching hospital.
Results: For EBUS GS 140 cases were carried out with mean lesion size 29 mm. Overall diagnostic sensitivity was 66%. For lesions not touching visceral pleura it was 74% compared with 35% where it was on the pleura ( P  < 0.01). For CT FNA 121 cases were carried out with mean lesion size 37 mm. The overall diagnostic sensitivity was 64%. Rate of pneumothorax and ICC placement in EBUS GS was 1 and 0% and in CTFNA was 28 and 6%, with P  < 0.001 for both.
Conclusion: Lesion location, in particular, connection to the visceral pleura, can improve decision-making in referral for either CT FNA or EBUS GS to maximize diagnostic yield and minimize pneumothorax rate.