CT引导下肺穿刺活检术出血与气胸并发症的主要影响因素分析

  目的  探讨CT引导下肺穿刺活检术的安全性，分析出血、气胸的高危因素，总结降低出血及气胸发生率的操作技巧。  方法  回顾性分析2018年9月—2020年4月在蚌埠医学院第一附属医院接受CT引导下肺穿刺活检术285例肺占位患者的临床资料，将患者性别、年龄、肿块大小、距胸膜距离、穿刺角度、穿刺深度、穿刺次数、有无肺基础疾病、病灶位置、患者体位等相关因素分为不同分类资料，χ2检验分析各统计资料之间在出血和气胸发生率有无差异性，logistic回归分析出血及气胸的独立危险因素。  结果  285例接受CT引导下肺活检穿刺术患者，出血52例(52/285，18.25%)，气胸43例(43/285，15.09%)。单因素检验分析显示术后出血在肿块距离胸膜的距离及穿刺针穿刺深度不同组别之间差异有统计学意义(均P < 0.05)；术后发生气胸在病灶距离胸膜距离、穿刺深度、穿刺次数、肺基础疾病组别之间差异有统计学意义(均P < 0.05)。Logistic回归分析穿刺距离为出血的独立危险因素；肺基础疾病、穿刺次数及穿刺距离是发生气胸的独立危险因素。  结论  CT引导下肺活检穿刺安全性高，严重并发症较少，有肺基础疾病、穿刺距离远、穿刺次数多是CT引导下肺穿刺活检术发生出血及气胸的主要危险因素，降低穿刺次数，避开肺大泡、空洞，选择相对较短的穿刺路径可有效降低肺穿刺活检的术后并发症。 

Analysis of the main influencing factors of bleeding and pneumothorax complication under CT-guided lung biopsy

  Objective  To explore the safety of CT-guided lung biopsy, analyze the high risk factors of bleeding and pneumothorax, and summarize the operational skills to reduce the incidence of bleeding and pneumothorax.  Methods  The clinical data of 285 patients with lung mass who underwent CT-guided lung biopsy in the first affiliated Hospital of Bengbu Medical College from September 2018 to April 2020 were analyzed retrospectively. The risk factors such as sex, age, tumor size, distance from pleura, puncture angle, puncture depth, puncture times, basic lung disease, lesion location, patient position and other related factors were divided into different grades. Chi-square test was used to analyze whether there were differences in the incidence of bleeding and pneumothorax among statistical data, and logistic regression was used to analyze the independent risk factors of bleeding and pneumothorax.  Results  CT-guided lung biopsy and puncture: a report of 285 cases, 52 (52/285, 18.25%) had bleeding and 43 (43/285, 15.09%) had pneumothorax. Univariate analysis showed that postoperative bleeding is related to the distance between the mass and the pleura and the depth of puncture needle (all P < 0.05). The occurrence of pneumothorax after surgery was related to factors such as the distance between the lesion and the pleura, the depth of puncture, the number of punctures, and basic lung disease (all P < 0.05). Logistic regression analysis analyzed that the puncture distance was an independent risk factor for bleeding; the basic lung disease, the number of punctures and the puncture distance were independent risk factors for pneumothorax.  Conclusion  CT-guided lung biopsy is safe and has fewer serious complications. Basic lung diseases, long puncture distance and more puncture times are the main risk factors of bleeding and pneumothorax in CT-guided lung biopsy. Reducing the number of punctures, avoiding pulmonary vesicles and cavities, and choosing a relatively short puncture path can effectively reduce the postoperative complications of lung biopsy.