慢性阻塞性肺疾病合并肺结节患者行CT引导下肺穿刺活检术的诊断有效性及安全性分析

Diagnostic Efficacy and Safety Analysis of CT-guided Lung Biopsy in Patients with Chronic Obstructive Pulmonary Disease Complicated with Pulmonary Nodules

目的:探讨CT引导下肺穿刺活检术对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺结节患者的诊断价值及安全性。方法:回顾性分析2019年1月1日—2020年1月25日重庆医科大学附属第一医院呼吸与危重症医学科收治的176例行CT引导下经皮肺穿刺活检术的肺结节患者临床、病理、影像、穿刺过程、术后并发症的病历资料。所有患者分为COPD组及非COPD组,比较两组患者之间的差异,分析气胸的风险因素、耐受性及与COPD严重程度的关系。结果:共收集患者176例,COPD组54例,非COPD组122例。手术操作成功率100%,确诊率85.9%。COPD组术后气胸16例(29.6%),显著高于非COPD组的19例(15.6%),差异有统计学意义(χ^(2)=4.642,P<0.05),均以少量气胸为主。COPD是肺穿刺活检术后气胸的独立高危因素。COPDⅠ-Ⅱ级与Ⅲ-Ⅳ级之间的气胸发生率比较,差异无统计学意义(χ^(2)=0.898,P>0.05)。两组患者术后发生气胸的患者,穿刺至出院时间及术后气胸的处理方式上(吸氧、抽气、闭式引流),差异无统计学意义(P>0.05)。结论:CT引导下经皮肺穿刺活检术是一种确诊率高、安全性好及微创的一种活检方法。COPD合并肺结节患者,特别是COPDⅠ-Ⅱ级患者的安全性及耐受性较好,没有增加医疗负担。

Objective:To investigate the diagnostic value and safety of CT-guided lung biopsy in patients with chronic obstruc⁃tive pulmonary disease(COPD)complicated with pulmonary nodules.Methods:The hospitalization data of 176 patients with pulmo⁃nary nodules who underwent CT-guided percutaneous lung biopsy in the hospital from January 1,2019 to January 25,2020 were retrospectively analyzed,such as clinical,pathological,imaging,puncture process,postoperative complications,etc.All patients were divided into COPD group and non-COPD group.The differences between the two groups were compared,and the risk factors,tolerance and relationship with COPD severity of pneumothorax were analyzed.Results:A total of 176 patients were collected,in⁃cluding 54 cases in the COPD group and 122 cases in the non-COPD group.There were 16 cases(29.6%)of postoperative pneumo⁃thorax in COPD group,which was significantly higher than 19 cases(15.6%)in non-COPD group,and the difference was statistical⁃ly significant(χ^(2)=4.642,P<0.05),all of which were dominated by a small amount of pneumothorax.COPD was an independent risk factor for pneumothorax after lung biopsy.There was no statistically significant difference in the incidence of pneumothorax be⁃tween COPD grades I-II and III-IV(χ^(2)=0.898,P>0.05).There was no statistically significant difference in the time from puncture to discharge and the treatment methods of postoperative pneumothorax(oxygen inhalation,air suction,closed drainage)between the two groups of patients with postoperative pneumothorax(P>0.05).Conclusion:CT-guided percutaneous lung biopsy is a biopsy method with high diagnostic rate,good safety and minimal invasiveness.The safety and tolerability of patients with COPD compli⁃cated with pulmonary nodules,especially patients with COPD grade I-II,are good,and there is no increased medical burden.