老年病人B超引导下经皮肺穿刺活检的诊断价值及其并发症影响因素分析

Safety and risk factors of complications of ultrasound-guided percutaneous transthoracic lung biopsy in elderly patients

目的评估老年病人B超引导下经皮肺穿刺活检的诊断价值及安全性,并分析影响并发症发生的危险因素。方法回顾性分析99例接受B超引导下经皮肺穿刺的老年病人的临床特点、穿刺并发症情况,分析穿刺并发症的影响因素。结果 88例病人明确病理诊断,诊断率为88.9%(88/99),其中恶性病变62例(62.6%),良性病变26例(26.3%)。发生的主要并发症为气胸(10.1%)和出血(7.8%)。多因素Logistic回归分析结果显示,老年病人经皮肺穿刺发生气胸的独立危险因素为病灶直径≤3.0 cm(OR=10.646,P<0.05)和合并慢性阻塞性肺疾病和(或)肺纤维化(OR=4.156,P<0.05);发生出血的独立危险因素为病灶直径≤3.0 cm(OR=5.123,P<0.05)和穿刺深度≥5.0 cm(OR=7.5,P<0.05)。结论老年病人B超引导下经皮肺穿刺诊断率及安全性较高,值得在临床推广应用。

Objective To evaluate the percutaneous transthoracic lung biopsy（PTLB） in safety and the diagnostic rate of ultrasound-guided elderly patients, and to analyze the risk factors for its complications. Methods A total of 99 elderly patients undergoing ultrasound-guided PTLB were selected, and the clinical data were collected, incidence of complication and its risk factors were analyzed retrospectively. Results Among the 99 cases, 88 cases got pathologic diagnosis, with a diagnostic rate of 88.9%（88/99）, and 62 cases （62.6%） were malignant and 26 cases（26. 3%） were benign. The main complications included pneumothorax and hemoptysis, accounting for 10. 1% （10/99） and 7.8% （7/99） respectively. Multiple Logistic regression analysis showed that lesion size ≤ 3.0 cm and chronic obstructive pulmonary disease （COPD） and pulmonary fibrosis were the independent risk factors for postoperative pneumothorax（ OR= 10. 646,4. 156, all P〈0. 05）. The lesion size ≤ 3.0 cm and puncture depth≥5.0 cm were the independent risk factors for postoperative hemorrhage （OR = 5. 123,7.5, all P〈 0.05）. Conclusions Ultrasound-guided PTLB is safe and the diagnostic rate is high in elderly patients, which is worthy of clinical popularization and application.