老年肺结节行CT引导下经皮肺活检术后并发症发生率与风险因素评估

Complication Occurrence in the Elderly with Pulmonary Nodules after CT-Guided Percutaneous Lung Biopsy and the Risk Factor Evaluation

中文关键词: 老年  肺结节  经皮肺活检  并发症  风险因素

英文关键词: elderly  pulmonary nodules  percutaneous lung biopsy  complication  risk factor

中文摘要:

      目的 探讨老年肺结节行CT引导下经皮肺活检术后并发症的发生率与风险因素.方法 收集2014年1月1日-2016年10月30日在第三军医大学第一附属医院介入病房行CT引导下经皮肺活检的＞60岁的老年肺结节和2016年8月1日-2016年10月30日老年肺部肿块患者的临床、影像以及术后并发症资料,比较2组差异;分析老年肺结节患者术后并发症的风险因素.结果 共收集老年肺结节221例,肺部肿块257例.肺结节组术后肺出血28例(12.66％),显著性高于肺部肿块组17例(6.61％)(P＜0.05),均以轻度为主;肺结节组术后气胸39例(17.65％)、胸腔出血1 1例(4.98％),肺部肿块组术后气胸41例(15.95％)、5例(1.95％),2组无显著性差异(P＞0.05),均没有出现严重并发症或死亡的病例.穿刺针经过斜裂、COPD或肺大泡、非上叶病灶、穿刺进针深度越深、穿刺角度越大以及穿刺时间越长,术后气胸的风险越大(P＜0.05).上叶病灶、取组织条数越多、穿刺进针深度越深、年龄越大以及肺结节越大,术后出血的风险增大(P＜0.05).结论 老年肺结节行CT引导下经皮肺活检术与老年肺部肿块相比,总体安全性好,但肺出血风险增加,以轻度为主.穿刺前需慎重考虑患者年龄、结节大小、位置,设计最佳的穿刺路径,减少并发症的发生.

英文摘要:

      Objective To investigate the complication occurrence in the elderly with pulmonary nodules after CT-guided percutaneous lung biopsy and to make the risk factor evaluation.Methods The clinical data,images and postoperative complication occurrence of the elderly ≥60 years old with pulmonary nodules receiving CT-guided percutaneous lung biopsy during the period from Jan.1,2014 to Oct.30,2016 (pulmonary nodule group) and those of the elderly with lung masses receiving CT-guided percutaneous lung biopsy during the period from Aug.1,2016 to Oct.30,2016 (lung mass group) were collected and a comparative study was made between the 2 groups and the risk factors of postoperative complications in the elderly with pulmonary nodules were analyzed.Results There were 221 cases in pulmonary nodule group and 257 cases in lung mass group;postoperative pneumothorax was found in 39 cases (17.65％) in pulmonary nodule group while in 41 cases (15.95 ％) in lung mass group,the difference between the 2 groups was of no significance (P ＞ 0.05);postoperative pulmonary hemorrhage was found in 28 cases (12.66％) in pulmonary nodule group,the occurrence was much higher than that in lung mass group (17 cases,6.61％) (P＜0.05);there existed no obvious difference in thoracic hemorrhage between the 2 groups and no serious complications or death occurred in both groups;biopsy needles through oblique fissure,COPD,bullae of lung,non-upper-lobe lesions,the deeper depth,the bigger angle and the longer during of biopsy were the risk factors of postoperative pneumothorax (P ＜ 0.05);upper-lobe lesions,more tissues taken,the deeper depth of biopsy,the older age of the patients and the bigger size of pulmonary nodules were the risk factors of postoperative hemorrhage (P＜0.05).Conclusions CT-guided percutaneous lung biopsy is safer in the elderly with pulmonary nodules than in the elderly with lung masses though the risk of postoperative lung hemorrhage is bigger.Careful consideration of patients' age,the size and location of nodules should be taken before biopsy so as to make out the best biopsy route and to decrease the complication occurrence.