CT引导下肺结节定位针定位在肺结节中的应用研究

Application of CT-guided pulmonary nodule localization needle positioning in pulmonary nodules

目的 探讨CT引导下肺结节定位针定位在肺结节中的应用效果。方法 回顾性分析323例肺结节患者的临床资料,根据术前是否行CT引导下肺结节定位针定位将患者分为定位组(n=173)与对照组(n=150)。观察2组患者术中出血量、手术时间、病灶一次性切除率、术后住院时间;记录定位组患者穿刺并发症及穿刺针脱落发生情况,采用Logistic回归分析导致穿刺并发症发生的危险因素,计算受试者工作特征(ROC)曲线下面积(AUC),评价模型准确性。结果 定位组和对照组患者病灶一次性切除率、术后住院时间比较差异无统计学意义(P> 0.05),定位组患者术中出血量、手术时间少/短于对照组(P <0.05)。定位组所有患者均定位成功,穿刺并发症发生率为25.43%。Logistic回归分析显示,进针深度> 30 mm、进针次数> 2次、病灶距肺边缘距离> 20 mm、慢性阻塞性肺疾病(COPD)病史是导致穿刺并发症发生的独立危险因素。根据穿刺并发症组建立预测模型,结果显示,训练组及验证组ROC曲线的AUC分别为0.748、0.760。结论 CT引导下定位针可准确定位肺结节,缩短手术时间,减少创伤。进针深度> 30 mm、进针次数> 2次、病灶距肺边缘距离> 20 mm、COPD病史是导致穿刺并发症发生的危险因素,临床预测模型对预测穿刺并发症具有较高的准确性。

Objective To investigate the application effect of CT-guided pulmonary nodule localization needle positioning in pulmonary nodules. Methods The clinical data of 323 pulmonary nodules patients were retrospectively analyzed and the patients were divided into the localization group( n = 173) and the control group( n = 150) according to whether CT-guided pulmonary noclule localization needle positioning was performed before surgery. The intraoperative blood loss,operation time,one-time resection of the lesion,postoperative hospitalization time of the two groups were observed,the incidence of puncture complications and localization needle came off of the localization group were recorded,the risk factors for puncture complications were analyzed by Logistic regression,and the area under the curve( AUC) of receiver operating characteristic( ROC) was calculated to evaluate the accuracy of the model. Results There was no significant difference in the one-time resection of the lesion or postoperative hospitalization time between the localization group and the control group( P > 0. 05). The intraoperative blood loss and the operation time of patients in the localization group were lower/shorter than those in the control group( P < 0. 05). All patients in the localization group were successfully positioned,and the incidence of puncture complications was 25. 43%. The Logistic regression analysis showed that the needle insertion depth > 30 mm,the needle insertion frequency > 2,the distance from the lesion to the lung edge > 20 mm and the history of chronic obstructive pulmonary disease( COPD) were the independent risk factors for puncture complications.The prediction model was established based on puncture complication group,and the results showed that the AUC of the ROC curves of the training group and the validation group were 0. 748 and 0. 760,respectively. Conclusion CT-guided localization needle can accurately locate pulmonary nodules,shorten the operation time,and reduce trauma. The needle insertion depth > 30 mm,the needle insertion frequency > 2,the distance from the lesion to the lung edge > 20 mm and the history of COPD are the risk factors for puncture complications,the clinical prediction model has high accuracy in predicting puncture complications.