CT引导下亚甲蓝和生物胶辅助肺结节定位的安全性和有效性及其影响因素
Safety,effectiveness and influencing factors of CT-guided percutaneous puncture with methylene blue and bio-glue for localizing pulmonary nodules
孟繁茂 1车云 1张国超 1任娜 1卢羿同 2孙慕菲 1赵亮1
作者信息
- 1. 国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院胸外科,北京 100021
- 2. 首都医科大学公共卫生学院,北京 100069
- 折叠
摘要
目的 探究CT引导下亚甲蓝+生物胶术前辅助肺结节定位技术的安全性、有效性及其影响因素.方法 收集2023年5月至2024年2月于中国医学科学院肿瘤医院完成的230例CT引导下亚甲蓝+生物胶术前肺结节定位操作的相关数据,包括患者基本信息、术中技术参数以及术中并发症发生情况.分析肺结节定位结果和术中并发症的发生情况,并通过多因素logistic回归分析定位成功和术中主要并发症(气胸)发生的影响因素.结果 230例中定位成功194例(84.3％).术中最常见的并发症为气胸,发生比例为10.4％(24例),肺出血和胸膜反应的发生比例较低,分别为6.1％(14例)、0.9％(2例).多因素logistic回归分析显示,术中气胸的发生是影响定位成功的唯一关键因素(OR=6.528,95％CI:1.974～21.585,P=0.002);结节位于肺下叶(OR=0.163,95％CI:0.040～0.671,P=0.012)、侧卧位定位(OR=6.163,95％CI:1.430～26.562,P=0.015)、疼痛等级≥6(OR=0.353,95％CI:0.127～0.980,P=0.046)是术中气胸的独立危险因素.结论 CT引导下亚甲蓝+生物胶术前辅助肺结节定位技术是安全有效的术前辅助定位技术.气胸的发生是定位成功与否最主要的影响因素,避免采用侧卧位和实施更有效的麻醉和止痛可以降低定位中气胸的发生率,提高定位的成功率.
Abstract
Objective To examine the safety,effectiveness,and influencing factors of CT-guided methylene blue and bio-glue preoperative assisted lung nodule localization technique.Methods Data of 230 cases of CT-guided methylene blue and bio-glue preoperative lung nodule localization operations completed in the Cancer Hospital of Chinese Academy of Medical Sciences between May 2023 and February 2024 were collected,including patient basic information,intraoperative technical parameters,and occurrence of intraoperative complications.The success rate of the technique and the incidence of intraoperative complications were analyzed,and the potential influencing factors of localization success rate and major complications(pneumothorax)were analyzed with logistic regression analysis.Results Among the 230 cases,the localization success rate was 84.3％(194 cases).The most common intraoperative complication was pneumothorax,with an incidence rate of 10.4％(24 cases),while the incidence rates of pulmonary hemorrhage and pleural reaction were lower,at 6.1％(14 cases)and 0.9％(2 cases)respectively.Multivariate logistic regression analysis showed that the only risk factor leading to localization failure was the occurrence of intraoperative pneumothorax(OR=6.528,95％CI:1.974～21.585,P=0.002).Nodule located in the lower lobe of the lung(OR=0.163,95％CI:0.040～0.671,P=0.012),lateral decubitus position for localization(OR=6.163,95％CI:1.430～26.562,P=0.015),and pain level ≥6(OR=0.353,95％CI:0.127～0.980,P=0.046)were independent risk factors for intraoperative pneumothorax.Conclusions Our data show that CT-guided methylene blue and bio-glue preoperative assisted lung nodule localization technique is a safe and effective preoperative assisted localization technique.The occurrence of pneumothorax is the most significant factor affecting localization success rate,and avoiding lateral decubitus position and implementing more effective anesthesia and pain control can reduce the incidence of pneumothorax during localization,thereby increasing the success rate of localization.
关键词
肺结节术前定位/CT辅助定位/亚甲蓝/生物胶/气胸Key words
Preoperative localization of pulmonary nodules/CT assisted localization/Methylene blue/Bio-glue/Pneumothorax引用本文复制引用
基金项目
首都卫生发展科研专项(2024-2-4027)
中国医学科学院医学与健康科技创新工程临床与转化医学研究基金(2022-12M-C&T-B-055)
中国癌症基金会北京希望马拉松专项基金(LC2021A02)
出版年
2024
NETL
NSTL
万方数据