肺穿刺活检中针胸膜夹角对气胸发生率的影响  

The influence of needle-pleural angle in pneumothorax rate of lung biopsy

作　　者：王培源[1] 王霞[2] 张林[1] 王旭[1] 李岩军[1] 张作兵[1] 

机构地区：[1]滨州医学院附属医院影像中心,山东滨州256603 [2]滨州医学院病理学教研室,山东滨州256603

出　　处：《中国临床医学影像杂志》2008年第12期879-882,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨肺内病变穿刺活检中影响气胸发生率的潜在因素,尤其是针胸膜夹角的影响。材料与方法:828例患者在CT导引下进行了1113次穿刺活检。分别记录患者一般情况、病变特点和操作过程等可能与气胸发生率相关的因素。在CT图像上测量穿刺针与胸膜之间的最小角度。将以上变量与气胸发生率进行相关性分析。结果:109例(13.16%)气胸中胸腔置管闭式引流25例,胸膜腔穿刺抽气13例。针胸膜夹角(<75°)及操作时间长短与气胸发生率相关。病变大小(<30mm)、位置(近肺底膈上)、穿刺点位置(侧胸或侧外方)及进针深度(>40mm)与气胸发生率具有显著相关关系。病变与胸膜接触、邻近胸膜肥厚粘连、病变侵犯胸膜或胸壁者气胸发生率较低。结论:小的针胸膜夹角及长的穿刺时间可能明显增加气胸的发生率。Objective： By retrospectively analysis the complications of 828 cases CT-guided transthorax needle biopsies （TNB）, to study the potential factors that may influence the incidence rate of pneumothorax, especially needle-pleural angle. Materials and Methods： In 828 patients, 1113 coaxial TNB were performed under CT-guidance. The possible factors of patients＇ characteristics, lesions and procedure variables were calculated. The minimal angle between needle and pleural was measured in CT imaging during the procedure. The variables were correlated with incidence of pneumothorax. Results： There were 109（13.16%） cases of pneumothorax in the study, 25（5%） biopsies treated with chest tube placement, and 13 cases with pleural punctural aspiration. Needle-pleural angles（〈75°） and dwelling time were associated with higher pneumothorax rate. The size of lesions （〈30mm）, location （close to the base of lung and the diaphragm）, puncture site （in the lateral or oblique chest wall） and the needle path length （〉40mm）, were associated with higher pneumothorax rates significantly. The pleural contact of lesions, pleural thickening and pleural or thorax invasion of lesions were associated with lower pneumothorax rate. Conclusion： A small puncture needle pleural angle and lung dwelling time may increase the pneumothorax rate significantly.

关 键 词：活组织检查 针吸 气胸 体层摄影术 X线计算机 

分 类 号：R561.4[医药卫生—呼吸系统] R814.42[医药卫生—内科学]