CT引导下肺实性结节切割活检术后出血与气胸的多因素分析

发布时间：2018-06-03 17:59

本文选题：肺结节 + CT引导　；参考：《介入放射学杂志》2017年07期

【摘要】：目的探讨CT引导下经皮穿刺肺实性结节切割活检术后并发出血、气胸的危险因素。方法回顾性分析肺实性结节(≤3 cm)320例经16 G半自动切割活检的临床及影像学资料,行单因素和多因素Logistic回归分析。结果活检术后针道出血发生率33.1%,气胸发生率18.1%,良恶性诊断准确率约99.6%。针道长度是出血的独立危险因素,针道每增加3 cm,风险增加3.881倍,且风险也随穿刺时间(P=0.061)和穿胸膜次数(P=0.062)呈正相关。年龄、位置和针-胸膜夹角是气胸独立风险因素,年龄每增加10岁,风险增加2.102倍;上肺叶病灶显著低于下肺叶;针-胸膜夹角每增加20°,风险增加2.413倍,肺气肿以微弱差距(P=0.086)被排除方程之外。以出血、气胸概率值绘制ROC曲线,AUC值分别为0.753和0.725。结论 CT引导下肺实性结节切割活检术后出血、气胸的发生受多种因素影响,术前仔细评估,术中操作熟练度可以有效预判和降低出血、气胸的发生。
[Abstract]:Objective to investigate the risk factors of hemorrhage and pneumothorax after percutaneous puncture biopsy of pulmonary solid nodules under CT guidance. Methods Retrospective analysis of the clinical and imaging data of 320 cases of pulmonary solid nodules (less than 3 cm) by 16 G semi-automatic cutting biopsy, and the analysis of single factor and multiple factor Logistic return. Results the incidence of needle bleeding after biopsy was 33.1%. The incidence of pneumothorax was 18.1%. The accuracy of the benign and malignant diagnosis of 99.6%. needle path was an independent risk factor for bleeding, with an increase of 3.881 times the risk of 3 cm in the needle path, and the risk also had a positive correlation with the puncture time (P=0.061) and the number of pleural times (P=0.062). Age, position and needle pleura angle were independent risk factors for pneumothorax, and the age was increased by 10 years of age. The risk increased 2.102 times; upper lobe lesions were significantly lower than that of the lower lobe; the needle - pleura angle increased by 20 degrees, the risk increased by 2.413 times, and the emphysema was excluded by a weak gap (P=0.086). The ROC curve was drawn with the probability of hemorrhage and pneumothorax, and the AUC value was 0.753 and 0.725., respectively, after CT guided pulmonary solid nodule biopsy bleeding, pneumothorax The incidence of bleeding and pneumothorax can be effectively predicted and evaluated by careful preoperative evaluation and intraoperative proficiency.
【作者单位】：第三军医大学西南医院介入科;
【分类号】：R563;R816.41

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