CT引导下125I粒子植入治疗肺癌术后气胸发生率的相关因素分析

The factor analysis of the incidence of pneumothorax after CT-guided 125I radioactive seed implantation for lung cancer

目的 分析影响CT引导下经皮肺穿刺125I粒子植入治疗肺癌术后气胸发生率的因素.方法 观察821例CT引导下经皮肺穿刺肺癌125I粒子植入术后患者198例发生气胸的情况,分析其出现的相关因素.结果 术后CT发现气胸198例,发生率为24.1％.发现植入针进针平均深度、患者是否合并慢性阻塞性肺疾病（COPD）、是否合并肺不张、植入针道数目、手术时间、进针角度及肿瘤直径7个因素与术后气胸发生率相关（x2=10.293、11.463、5.310、8.868、13.348、9.326、16.504,P＜0.05）.其中COPD患者176例术后发生气胸65例（36.9％）;植入针进针的深度＜6 cm（205例）、8 ～ 12 cm（378例）及＞12 cm（238例）患者术后发生气胸分别为29例（14.1％）、98例（25.9％）、71例（29.8％）;植入针道数目＜5（183例）、5～10（408例）、＞10（230例）的患者术后发生气胸例数分别是31例（16.9％）、92例（22.5％）、75例（32.6％）;手术时间＜10 min（198例）、10 ～ 20 min（412例）、＞30 min（211例）的患者术后发生气胸分别为27例（13.6％）、101例（24.5％）、70例（33.2％）;合并肺不张患者132例术后发生气胸的19例（14.4％）.其中前4项经多因素logistic回归分析是气胸发生的危险因素（OR=1.676、2.147、1.827、2.368,P＜0.05）,最后1项是气胸的保护因素（OR=0.367,P＜0.05）.结论 当病灶离胸壁远,患者合并有COPD,术中植入针道较多的患者,粒子植入前要充分考虑到气胸发生的可能,减少穿刺针数目及加快手术时间,可使CT引导下经皮肺癌125I粒子植入术后气胸发生率大为降低.

Objective To analyze the impact factors of incidence of pneumothorax after CT guided puncture with radioactive 125I seed implantation in lung cancer patients.Methods 821 cases with lung cancer were treated with CT-guided percutaneous with radioactive particles implantation.198 cases of pneumothorax patients were collected.The impact factors of incidence of pneumothorax were analyzed by parallel unconditioned logistic regression.Results 24.1% （198/821） of cases had pneumothorax after CT guided puncture.Single variate analysis showed that the incidence of pneumothorax was ralated with seven factors,such as patients with the average depth of implanted needle,whether patients with COPD（chronic obstructive pulmonary diseases）,atelectasis,implantation pin number and operation time,puncture angle,and the diameter of the tumor（x2 =10.293,11.463,5.310,8.868,13.348,9.326,16.504,P 〈0.05）.176 patients of intercurrent COPD with postoperative pneumothorax suffered from 65 cases.The cases of distance between the chest wall and needle less than 6 cm（205 cases）,8-12 cm（378 cases）and greater than 12 cm （238 cases）,the postoperative pneumothorax occurred in 29 （14.1%）,98 （25.9%）,71 （29.8%）cases,respectively.The number of needles were less than 5（183 cases）,5-10 （408 cases）,more than 10 （230 cases）,the postoperative pneumothorax occurred in 31 （16.9%）,92 （22.5 %）,75 （32.6%）,respectively.The surgery time was less than 10 min（198 cases）,10-20 min（412 cases）and more than 30 min（211 cases）,the postoperative pneumothorax occurred in 27（13.6%）,101 （24.5%）,70（33.2%） respectively.19 cases（14.4%） with COPD （132 case） suffered from pneumothorax.The multivariate logistic regression analysis showed that the prior four factor were risk factors of pneumothorax （OR =1.676,2.147,1.827,2.368,P 〈0.05）,and the last one is protective factor（OR =0.367,P 〈 0.05）.Conclusions COPD disease history,long distance between lesion and chest wall,plenty of needles surgery time can affect the incidence of pneumothorax after CT guided puncture with 125I implantation in lung cancer patients.