CT引导下Hook-wire定位术在肺小结节患者中的临床应用及并发症发生因素分析

Factors affecting the occurrence of complications in clinical application of CT guided Hook-wire localization for small pulmonary nodules

关键词:  肺小结节  CT 引导下定位  Hook-wire

Key words:  small pulmonary nodule  CT guided localization  Hook-wire complications

摘要:

目的　分析胸腔镜术前 CT 引导下 Hook-wire定位术患者的临床及影像学资料，总结Hook-wire 定位术并发症发生的因素。方法　将2016 年 1 月至 2016 年 12 月143例因肺小结节（small pulmonary nodule，SPN）行术前 Hook-wire 定位术的患者作为研究对象。术前获取患者肺部薄层扫描 CT 图像，分析结节位置特点及性质，设计穿刺计划并对患者进行穿刺定位。定位术后对患者的临床资料及影像学资料进行统计分析。结果　共定位病灶166枚，手术前定位针脱出 2 例，定位成功率 98.8%。共有 62 例发生了气胸，气胸发生率 37.34%。52 例发生了肺内出血，肺内出血发生率 31.32%。影响气胸发生的因素包括：病变前缘距胸膜距离（P=0.002）、病变后缘距胸膜距离（P=0.006）、病变中心距胸膜距离（P=0.003）。气胸的发生与定位体位的选择有关（P=0.014），其中仰卧位的气胸发生率较低为 19.0%，左侧卧位的气胸发生率最高为 54.0%。气胸的发生与定位穿刺次数有关（P=0.001），穿刺次数增多，发生气胸发生率增大。气胸的发生与穿刺针是否贴近肋骨有关（P=0.000）。影响肺内出血发生的因素包括：穿刺针进肺深度（P=0.002）和定位针留置入肺深度（P=0.043）。结论　CT 引导下 Hook-wire 定位术并发症虽较常发生，但多较轻微或无明显临床症状，大部分无需进行特殊的处理。故Hook-wire 定位术是一种安全有效的术前定位方法。

Abstract:

Objective　 To explore the risk factors of complications of CT guided Hook-wire localization technique in clinical application. 　Methods　 We collected 143 patients data with small pulmonary nodules (SPNs) (166 nodules in total) used CT-guided hook-wire localization technique from January 2016 to December 2016, retrospectively. Preoperative thin slice image of lung was used to analyze the characteristics of the nodules and localize the lesions. Then the plan of CT-guided hook-wire localization technique was determined. The clinical data and imaging data of the patients were statistically analyzed. 　Results　 The success rate was 98.8%, except that wire dislocation occurred before the operation in 2 cases. The incidence of pneumothorax and pulmonary hemorrhage was 37.34% (62 of 166 sessions), 31.32% (52 of 166 sessions), respectively. The risk factors of pneumothorax included the distance to pleura from the front edge (P=0.002), the back edge (P=0.006), the center (P=0.003) of lesion, patient position（P=0.014），number of the hook wires used（P=0.001），the needle close to the ribs（P=0.000）.The risk factors of pulmonary hemorrhage included the intrapulmonary depth of the puncture needle (P=0.003) and the intrapulmonary depth of the Hook-wire (P=0.043). 　Conclusion　 CT guided Hook-wire localization technique is a safe and effective preoperative localization method. Complications related to CT guided preoperative Hook-wire placement often occurred, but all complications were mild.