CT引导下老年人经皮肺穿刺的安全性和影响因素分析

Safety of CT-guided percutaneous lung biopsy in elderly and its risk factors

目的 评估CT引导下老年人经皮肺穿刺的安全性,分析并发症发生的影响因素.方法 回顾性分析204例年龄≥65岁进行CT引导下经皮肺穿刺患者的临床特征、并发症发生情况和影响因素. 结果 204例患者中发生气胸31例（15.2％）,发生出血44例（21.6％）.Logistic回归分析结果显示,老年人经皮肺穿刺发生气胸的独立危险因素为穿刺针道长度≥5.00 cm、病灶大小≤2.00 cm和病灶周围存在肺气肿或肺大疱（OR-4.05、2.54、3.97,均P＜0.05）;发生出血的独立危险因素为病灶增强CT扫描增强程度＞40 HU、穿刺针针道长度≥5.00 cm和病灶大小≤2.00 cm（OR=2.27、2.82、2.33,均P＜0.05）.所获得的气胸预测方程的敏感度为87.1％,特异度为49.1％;出血预测方程的敏感度为54.5％,特异度为80.8％. 结论 穿刺针道长度、病灶大小及病灶周围肺气肿或肺大疱的存在与老年人CT引导下经皮肺穿刺发生气胸有关;穿刺针道长度、病灶大小及病灶CT扫描增强程度与老年人CT引导下经皮肺穿刺发生出血有关.

Objective To evaluate the safety of CT guided percutaneous lung biopsy in the elderly,and to analyze the risk factors for its complications.Methods Totally 204 elderly patients aged ≥65 years underwent transthoracic needle biopsy under CT guidance.Clinical data,complication and its risk factors were analyzed retrospectively.Results The complications included pneumothorax accounting for 15.2% （31/204）,hemoptysis 21.6% （44/204）,and no mortality was found.Logistic regression analysis showed that needle path ≥5.00 cm,lesion size ≤2.00 cm and emphysema around the lesion were the independent risk factors for postoperative pneumothorax （OR=4.05,2.54 and 3.97,all P〈0.05）.Meanwhile,the enhancement degree by CT 〉40 HU,needle path ≥5.00 cm and lesion size ≤2.00 cm were the independent risk factors for postoperative bleeding （OR=2.27,2.82 and 2.33,all P〈0.05） in elderly patients undergoing lung biopsy.The sensitivity and specificity for postoperative pneumothorax and bleeding obtained by forecasting equation were 87.1% and 49.1%,54.5% and 80.8% respectively.Conclusions The length of needle path,lesion size and emphysema around the lesion are correlated with pneumothroax,and length of needle path,lesion size and the CT enhancement degree are correlated with bleeding after percutaneous lung biopsy in the elderly.