CT引导肺穿刺活检技术发生气胸风险及相关技术因素分析

Risk of pneumothorax in CT-guided percutaneous lung biopsy and analysis of related technical factors

目的 分析CT引导肺穿刺活检(percutaneous lung biopsy,PLB)时气胸的发生率及其相关技术因素,为降低该技术的气胸发生风险提高科学依据。方法 CT引导PLB是一种高度精准的微创技术,拥有高准确性、实时监控和适应性强等优势,被广泛应用于肺部病变的诊断。为了有效控制和消除非CT引导PLB技术引发的潜在混杂因素(年龄、基础疾病等临床相关因素),采用前瞻性队列研究,纳入2017—2023年在北京医院接受CT引导PLB技术的患者。比较患者的临床资料和技术资料,使用多因素logistic回归分析确定气胸发生的相关技术因素。结果 本研究中心数据显示,CT引导PLB技术的气胸发生率为21.4%。在1 732例患者中,根据是否发生气胸分为气胸组(371例)和非气胸组(1 361例)。与非气胸组比较,气胸组的平均年龄更高(68.4岁±8.2岁vs 60.1岁±10.5岁,P<0.001)。此外,气胸组的肺气肿或肺大疱的发生率(27.0%vs 22.1%,P=0.005)、病变大小≤2 cm(13.5%vs 10.1%,P<0.001)、与胸壁距离≥2 cm(73.0%vs 62.5%,P=0.016)、支气管受累(48.5%vs 16.3%,P=0.002)和穿刺深度≥5 cm(59.6%vs 44.6%,P<0.001)的比例均明显高于非气胸组。多因素logistic回归分析显示,两项CT引导PLB技术因素:病灶距胸壁距离≥2 cm(OR=1.341,95%CI:1.065-1.687,P=0.017)和针头插入深度≥5 cm(OR=1.362,95%CI:1.077-1.726,P=0.012)及两项临床因素:肺大疱或肺气肿(OR=1.583,95%CI:1.084-2.314,P=0.020)和病变大小≤2 cm(OR=1.364,95%CI:1.093-1.699,P=0.007)是发生气胸的重要影响因素。结论 患者在接受CT引导PLB技术时,存在影响气胸发生的两种技术因素和两种临床因素。基于这些结果,建议在临床实践中进行个体化评估,以降低气胸的发生率,改善患者的治疗效果。

Objective To analyze the incidence of pneumothorax during CT-guided percutaneous lung biopsy(PLB) and its related technical factors,providing a scientific basis for reducing the risk of pneumothorax associated with this technique.Methods CT-guided PLB was a highly precise minimally invasive technique,characterized by high accuracy,real-time monitoring,and strong adaptability,widely used for diagnosing pulmonary lesions.To effectively control and eliminate potential confounding factors unrelated to CT-guided PLB(such as age and underlying diseases),a prospective cohort study was conducted,including patients who underwent CT-guided PLB at Beijing Hospital from 2017 to 2023.Baseline clinical and technical data of the patients were compared,and multifactorial logistic regression analysis was employed to identify the technical factors related to the occurrence of pneumothorax.Results Data from our center indicated that the incidence of pneumothorax associated with CT-guided PLB was 21.4%.Among 1 732 patients,those who experienced pneumothorax(371 cases) were compared with those who did not(1 361 cases).The pneumothorax group had a significantly higher average age(68.4 years±8.2 years vs 60.1 years±10.5 years,P<0.001).Additionally,the rates of emphysema or bullae(27.0% vs 22.1%,P=0.005),lesion size ≤2 cm(13.5% vs 10.1%,P<0.001),distance from the chest wall ≥2 cm(73.0% vs 62.5%,P=0.016),bronchial involvement(48.5% vs 16.3%,P=0.002),and needle insertion depth ≥5 cm(59.6% vs 44.6%,P<0.001) were significantly higher in the pneumothorax group compared to the non-pneumothorax group.Multifactorial logistic regression analysis revealed that two technical factors:distance from the lesion to the chest wall ≥2 cm(OR=1.341,95% CI:1.065-1.687,P=0.017) and needle insertion depth ≥5 cm(OR=1.362,95% CI:1.077-1.726,P=0.012),along with two clinical factors:presence of bullae or emphysema(OR=1.583,95% CI:1.084-2.314,P=0.020) and lesion size ≤2 cm(OR=1.364,95% CI:1.093-1.699,P=0.007),were significant influencing factors for the occurrence of pneumothorax.Conclusions During CT-guided PLB,there are two technical factors and two clinical factors that influence the occurrence of pneumothorax in patients.Based on these results,it is recommended to conduct individualized assessments in clinical practice to reduce the incidence of pneumothorax and improve treatment outcomes for patients.