在视频辅助胸腔镜手术前经过皮肤计算机断层扫描指导的微线圈定位的患者中,更高度的肺内出血的风险和保护因素
Yunxin Li1, Yanyan Xu2, Hongxiang Feng3
1Department of Radiology, Yantaishan Hospital, Yantai, China.
Journal of thoracic disease
|October 29, 2025
概括
在对VATS进行CT导向定位时重复插入微线圈会增加出血风险. 诸如肺胸部和较大的结节大小等因素可以防止出血.
科学领域:
- 胸部外科手术 胸部外科手术
- 干预性放射学 干预性放射学
- 肺部医学 肺部医学
背景情况:
- 在视频辅助胸腔镜手术 (VATS) 之前,使用计算机断层扫描 (CT) 引导的微线圈定位.
- 这种手术存在肺内出血的风险.
- 识别出血的预测因素对于患者的安全至关重要.
研究的目的:
- 在CT导向微线圈定位后,确定较高级别肺内出血 (≥2级) 的独立预测因子.
- 优化VATS患者选择和程序规划.
主要方法:
- 在VATS (2016-2020) 之前,对432名接受微线圈定位的患者进行了回顾性分析.
- 放射性分级出血的严重程度 (等级0-4).
- 单变量和多变量逻辑回归以确定显著因素 (P<0.05).
主要成果:
- 肺内出血发生在37.27%的手术中;高度出血发生在9.49%的手术中.
- 重复插入是高度出血的唯一显著危险因素 (OR=9.712,P<0.001).
- 保护因素包括肺胸,较大的结节大小 (>5毫米),较长的肺-微线圈距离 (>20-30毫米),以及较低的肺辐射密度 (≤-850 HU).
结论:
- 重复插入微线圈是CT引导局部化期间肺内出血的重要危险因素.
- 肺胸部,较大的结节大小,增加的膜-微球距离,以及较低的肺密度似乎具有保护作用.
- 这些发现支持在VATS之前对CT导向微线圈定位的风险分层患者管理.
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