CT 引导下经皮肺穿刺活检的临床应用及其并发症影响因素

目的探讨CT引导下经皮肺穿刺活检临床价值以及导致其并发症的影响因素。方法回顾2009年1月～2013年12月浙江省金华市中心医院诊断并治疗的221例肺部周围性肿块患者．所有患者均在CT引导下经皮肺穿刺活检，总结其诊断准确率和并发症的发生率及其影响因素。结果221例患者中，CT引导下经皮肺穿刺活检检出140例恶性肿瘤，后经证实，恶性肿瘤诊断正确率为88．61％，主要并发症为气胸、咯血和呼吸困难。在CT引导下经皮肺活检穿刺术并发症影响的单因素分析中，年龄〉60岁，病灶大小≤3cm、穿刺深度〉5cm、合并肺部疾病、穿刺时间≥20min、穿刺次数〉1次、病灶胸膜距离〉1cm的患者并发症发生均较高（P〈0．05或P〈0．01）。Logistic回归分析结果发现：年龄〉60岁，病灶大小≤3cm、穿刺深度〉5cm、合并肺部疾病、穿刺时间≥20min、穿刺次数〉1次是导致CT引导下经皮肺活检穿刺术并发症发生的危险因素（OR〉1，P〈0．05）。结论CT引导下经皮肺穿刺活检具有很高的临床应用价值，针对患者个人情况，选择合适的穿刺方案并熟练掌握穿刺技术有利于减少穿刺活检并发症的发生。

Clinical application of CT-guided percutaneous puncture lung biopsy and its influencing factors of complications

Objective To discuss the clinical value of CT-guided percutaneous puncture lung biopsy and its influenc- ing factors of complications. Methods 221 cases of peripheral lung tumors from January 2009 to December 2013 diag- nosed and treated in Municipal Central Hospital of Jinhua City were reviewed, all patients were percutaneous puncture lung biopsied under CT-guided, the diagnostic accuracy, the incidence of complications and its influencing factors were summarized. Results 140 cases of lung cancer were detected under CT-guided percutaneous biopsy in 221 cases, can- cer diagnostic accuracy was 88.61% after proved. The main complication was pneumothorax, hemoptysis and dyspnea. In the univariate analysis of influencing factors of complications under CT-guided percutaneous puncture lung biopsy. Patients whose age〉 60 years, tumor size ≤ 3 cm, puncture depth 〉 5 cm, pulmonary disease, puncture times ≥ 20 min, puncture frequency〉1, or distance pleural lesions〉1 cm had a higher rate of complications （P 〈 0.05 or P 〈 0.01）. In Logistic regression analysis, age 〉 60 years, tumor size≤3 cm, puncture depth〉5 cm, pulmonary disease, puncture times≥20 min, puncture frequency〉t were the risk factors for complications（OR 〉 1, P 〈 0.05）. Conclusion There is a high clinical value of percutaneous lung biopsy under CT-guided, for individual patient, to select the appropriate punc- ture program and master puncture technique are help to reduce the incidence of biopsy complications.