肺组织切除前Hook-wire定位穿刺并发症的危险因素分析

Risk factors for complications of Hook-wire positioning puncture before lung tissue resection

目的研究肺组织切除前Hook-wire定位穿刺并发症的危险因素。方法选取104例拟接受胸腔镜下肺组织切除术的肺小结节患者,均于术前采用Hook-wire进行定位穿刺。记录术前结节的最大径、位置及结节与胸膜的距离;于术中评价Hookwire定位的准确性;于术后记录结节的良恶性;观察患者气胸、局部疼痛、肺出血及咳嗽等并发症发生情况。对引起并发症的影响因素进行单因素分析和二元Logistic回归分析。结果患者平均穿刺时间为(14.3±4.6)min,穿刺成功率为93.64%(103/110);并发症发生率为27.88%(29/104),3例出现咳嗽,8例出现肺周出血,8例出现微量气胸,10例出现局部疼痛。所有患者均顺利完成手术,均无中转开胸。术后病理结果显示,20个肺小结节为良性病变,37个为浸润前病变,7个为转移瘤,46个为浸润性病变。患者性别、年龄、吸烟史、结节良恶性对并发症的发生无明显影响(P>0.05);结节位置、肺部疾病史、穿刺时间、结节与胸膜的距离及结节个数对并发症的发生有显著影响(P<0.05)。多因素二元Logistic回归分析结果显示,有肺部疾病史、穿刺时间>15 min及结节与胸膜的距离≤2 cm是引起并发症的独立危险因素[OR=18.011,95%CI(2.493~130.144);OR=24.508,95%CI(3.479~172.632);OR=130.712,95%CI(11.986~1425.446)]。有肺部疾病史是引起咳嗽的独立危险因素[OR=7.330,95%CI(1.232~43.623)]。结节与胸膜的距离≤2 cm是引起肺周出血的独立危险因素[OR=26.523,95%CI(1.239~567.636)]。穿刺时间>15 min、结节与胸膜的距离≤2 cm是引起微量气胸的独立危险因素[OR=3.536,95%CI(1.369~9.131);OR=26.206,95%CI(1.885~364.410)]。穿刺时间>15 min和结节与胸膜的距离≤2 cm是引起局部疼痛的独立危险因素[OR=3.789,95%CI(1.335~10.748);OR=27.688,95%CI(3.585~213.851)]。结论肺组织切除前Hook-wire定位穿刺伴有一定的并发症,但是均较轻微;有肺部疾病史、穿刺时间>15 min及距胸膜的距离≤2 cm是引起并发症的独立危险因素。

Objective To investigate the risk factors for complications of Hook-wire positioning puncture before lung tissue resection.Methods A total of 104 patients with small pulmonary nodules who intended to receive thoracoscopic lung tissue resection were selected,and all patients were punctured with Hook-wire before operation.The maximum diameter and location of the nodules and the distance between nodules and pleura were recorded before the operation;the accuracy of Hook-wire positioning was evaluate during the operation;the benign and malignant nodules were recorded after the operation;the occurrence of complications such as pneumothorax,local pain,pulmonary hemorrhage,and cough of patients were observed.Univariate analysis and binary Logistic regression analysis were used to analyze the influencing factors for complications.Results The average puncture time of the patients was(14.3±4.6)minutes,and the puncture success rate was93.64%(103/110);the complication incidence was 27.88%(29/104),3 cases had cough,8 cases had peripulmonary hemorrhage,8 cases had micropneumothorax,and 10 cases had local pain.All the patients successfully completed the operation,and none of them was converted to thoracotomy.Postoperative pathological results showed that 20 small pulmonary nodules were benign lesions,37 were pre-infiltration lesions,7 were metastatic tumors,and 46 were infiltrating lesions.The patient’s gender,age,smoking history,and benign and malignant nodules had no significant effect on the occurrence of complications(P>0.05);the location of nodules,history of pulmonary disease,puncture time,distance between nodules and pleura,and the number of nodules had significant effects on the occurrence of complications(P<0.05).Multivariate binary Logistic regression analysis showed that the history of pulmonary disease,the puncture time>15 minutes and the distance between nodules and pleura≤2 cm were the independent risk factors for complications[OR=18.011,95%CI(2.493 to 130.144);OR=24.508,95%CI(3.479 to 172.632);OR=130.712,95%CI(11.986 to 1425.446)].The history of pulmonary disease was an independent risk factor for cough[OR=7.330,95%CI(1.232 to 43.623)].The distance between nodules and pleura≤2 cm was an independent risk factor for peripulmonary hemorrhage[OR=26.523,95%CI(1.239 to 567.636)].The puncture time>15 minutes and the distance between nodules and pleura≤2 cm were the independent risk factors for micropneumothorax[OR=3.536,95%CI(1.369 to 9.131);OR=26.206,95%CI(1.885 to 364.410)].The puncture time>15 minutes and the distance between nodules and pleura≤2 cm were the independent risk factors for local pain[OR=3.789,95%CI(1.335 to 10.748);OR=27.688,95%CI(3.585 to 213.851)].Conclusion Certain complications are occured during Hook-wire positioning puncture before lung tissue resection,but they are all mild.The history of pulmonary disease,puncture time>15 minutes and the distance between nodules and pleura≤2 cm are the independent risk factors for complications.