CT导向下经皮肺胸膜外定位法自动切割活检并发症的相关因素分析

目的 统计CT导向下经皮肺胸膜外定位法(EPL)自动切割活检(ACNB)并发症,分析影响因素.方法 回顾性总结武汉大学中南医院2005年3月至2009年9月480例EPL法ACNB结果,对气胸、出血及咯血的相关因素行多因素非条件 Logistic 回归分析.结果 ACNB准确率95.0%,每例时间(16±2)min,活检针肺内停留时间<20 s.气胸率14.8%,迟发性气胸率1.5%,引流率0.4%;肺气肿、穿刺深度及病灶大小(OR值7.991、1.083及0.945)为气胸独立性影响因素.出血率18.1%,咯血率5.4%;穿刺深度、肺气肿及穿刺次数(OR值1.143、0.712及0.521)为出血独立性影响因素,穿刺深度及肺气肿(OR值1.077及0.578)为咯血独立性影响因素.出血并气胸率3.5%,胸膜反应1例,术后疼痛3例.严重并发症率3.1%.结论 CT导向下EPL法ACNB诊断准确率高,气胸及出血是主要并发症.伴有肺气肿、肺内穿刺及病灶≤10 mm气胸率高,穿刺深度>10 mm及>20mm、伴有肺气肿及穿刺次数多出血率高,穿刺深度>20 mm咯血率高.

The factor analysis of the incidence of complication in CT-guided lung automated cutting needle biopsy with extrapleural locating method

Objective To evaluate the complication rate and analyze its impact of multiple facts of CT-guided percutaneous lung automated cutting needle biopsies (ACNB) with extrapleural locating method (EPL).Methods Retrospective study where information was obtained from the department of medical imaging,the sign of complication after 480 cases CT-guided ACNB with EPL was observed and its relationship with multiple factors were analyzed by multiple logistic regression model.Results The diagnostic accuracy was made in 456 cages (95.0%).The length of the biopsy procedures was 16±2 min and the time of the biopsy needle in pulmonary parenchyma was <20 s.Senventy-one (14.8%) cases presented pneumothorax which include 7(1.5%) cases later pneumothorax,and 2 (0.4%) required chest tube insertions.The multivariate logistic regression analysis showed that emphysema,depth of intrapulmonal biopsy path and lesion size were sole effective factors of pneumothorax (OR=7.991,1.083,and 0.945 respectively).Lesions with emphysema,depth of intrapulmonal biopsy path and lesion size ≤10 mm had higher pneumothorax rates.Eight-seven (1 8.1%) cases presented pulmonary hemorrhage and twenty-six (5.4%) presented hemoptysis.The multivariate logistic regression analysis showed that depth of intrapulmonal biopsy path,emphysema,and number of pleural needle passes were sole effective factors (OR =1.143,0.712,and 0.521,respectively) of pulmonary hemorrhage.In patients with depth >10 mm or 20 mm.emphysema and number of pleural needle passes had higher hemorrhage rates.The multivariate logistic regression analysis showed that depth of intrapulmonal biopsy path and emphysema were sole effective factors (OR=1.077,and 0.578,respectively) of hemoptysis.Lesions with depth >20 mm had higher hemoptysis rate.One cage with pulmonary Cryptococcus presented pleural reaction,and three cases had the insistent pain.The total number of severe complications was 15 (3.1%) cases.Conclusion ACNB with EPL was a accurate method for diagnosing pulmonary lesions.ACNB can be safely performed,which reduces the rate of pneumothorax and hemorrhage.Pneumothorax rate was influenced by emphysema,depth of intrapulmonal biopsy path and lesion size ≤10 mm. Hemorrhage was related with depth > 10 mm or 20 mm,emphysema and number of pleural needle passes.Hemoptysis was related with depth of intrapulmonal biopsy path >20 mm.Later and severe complications should be considered in procedure.