CT引导下Hook-wire穿刺定位肺小结节的应用及并发症情况分析

Application and complication of CT guided Hook-wire localization of small lung nodules with thoracoscopic surgery

目的回顾分析在我单位先行CT引导下Hook-wire穿刺定位、后行胸腔镜(Video-assisted thoracoscopic surgery,VATS)手术处理的肺小结节患者的临床资料,统计定位情况及并发症情况。方法汇总2018-3月至2019-8月我科收治的,行术前CT引导下Hook-wire穿刺定位的,62例共68枚,最大径≤2.0cm的肺结节患者的临床数据,统计穿刺时间(指每个病例总穿刺时间,后统一表述为穿刺时间)、穿刺成功率、病理结果、并发症情况;并对可能影响并发症发生的因素进行统计学分析。结果研究纳入62例共68枚肺结节(男性26例,女性36例),平均穿刺时间14.4min±5.3min(8min^35min);术中发现2例脱钩,穿刺成功率97.1%;8例出现并发症(4例微量气胸,3例肺周出血,1例针道出血),并发症发生率11.8%。并发症病例均无需进一步处理,2例脱钩患者均根据术中肺表面穿刺点而顺利完成手术。术后病理结果:良性病变8例,浸润前病变(原位腺癌+微浸润腺癌)18例;转移瘤4例,浸润性病变38例。单因素分析显示:年龄(是否大于60岁)、既往肺部疾病史(慢支、肺气肿、肺部感染、肺结核、肺部肿瘤等)、结节距胸膜距离、穿刺时间,对并发症发生有显著影响(P<0.05);多因素二元Logistic回归分析显示肺部疾病史(OR=0.055;P=0.009),结节距胸膜距离(OR=0.011;P=0.003),穿刺时间(OR=0.024;P=0.001),是并发症发生的独立危险因素。结论术前CT引导下肺小结节Hook-wire穿刺定位法,有一定的并发症发生率,但均较轻微,大多数无需进一步处理。此方法安全有效,值得临床推广。另外,既往肺部疾病史、穿刺时间、结节距胸膜距离,是并发症发生的独立危险因素。

Objective To retrospectively analyze the application and complication of CT guided Hook-wire localization of small lung nodules with thoracoscopic surgery.Methods There were 62 patients and 68 nodules which were not more than 2.0 cm in our department from March 2018 to August 2019.It summarized the time of location,success rate,complications and postoperative pathology of nodules.Furthermore,it used univariate analysis and logistic regression to evaluate the association between factors and complications.Results There were 62 patients(men 26,women 36)underwent CT-guided Hook-wire localization with 68 nodules.The mean localization time was 14.4min±5.3min(8~35min).Due to the 2 cases of Hook-wire falling off,the success rate was 97.1%.Complications after localization found in 8 cases(11.8%),and all of them did not need any treatment.It contained 4 cases of pneumothorax,3 cases of hemothorax and 1 case of centesis point bleeding.Post-operation pathological report showed 8 benign lesions,18 pre-invasive lesions(adenocarcinoma in situ,AIS and microinvasive adenocarcinoma,MIA),and 38 invasive adenocarcinoma lesions.An univariate analysis showed that age(over 60 or not),pulmonary disease history(like pneumonia,emphysema,chronic bronchitis,pulmonary tuberculosis and lung cancer),lesions from pleural distance,time of localization were associated with the complications(P<0.05).Besides,it found that pulmonary disease history(OR=0.055;P=0.009),lesions from pleural distance(OR=0.011;P=0.000),and time of localization(OR=0.024;P=0.001)were independent risk factors by using dualistic logistic regression.Conclusion Although there may be amount of complications,the CT-guided Hook-wire puncture process has been confirmed to be safe and feasible.However,pulmonary disease history,lesions from pleural distance,and the time of localization are independent risk factors by using dualistic logistic regression.