经支气管肺活检术与气胸风险增加相关 - 一项回顾性研究。
Transbronchial biopsy from the upper pulmonary lobes is associated with increased risk of pneumothorax - a retrospective study.
机构信息
Department of Respiratory Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavska 20, 62500, Brno, Czech Republic.
Department of Anesthesiology and Intensive Care, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
出版信息
BMC Pulm Med. 2019 Mar 1;19(1):56. doi: 10.1186/s12890-019-0820-z.
BACKGROUND
Pneumothorax (PTX) is one of the most common complications of transbronchial biopsy (TBB). Previous research suggests that upper pulmonary lobe TBB may be associated with increased risk of PTX development. The aim of this study was to compare the risk of PTX after TBB performed from different pulmonary lobes.
METHODS
All bronchoscopic records from the period January 1st, 2015 - December 31st, 2017 (from the Department of Respiratory Diseases, University Hospital Brno, Czech Republic) were retrospectively analyzed. Of the 3542 bronchoscopic records, 796 patients underwent TBB and were further analyzed. Basic demographic data, TBB procedure-related factors, smoking history and radiological features were analyzed. Furthermore, in patients who developed PTX, PTX onset, PTX symptoms, distribution of the abnormal radiological findings and duration of hospitalization were also analyzed.
RESULTS
Patients who developed PTX had significantly lower body mass index (BMI) and more than 4 samples taken during procedure (all p < 0.05). TBB performed from the left upper pulmonary lobe was associated with a significant risk of PTX development (OR 2.27; 95% CI 1.18-4.35; p = 0.02). On the contrary, TBB performed from the right lower lobe was associated with a significant reduction of risk of developing PTX (OR 0.47; 95% CI 0.22-0.98; p = 0.04). Logistic regression analysis showed BMI (OR 1.08; 95% CI 1.02-1.16; p = 0.01), left upper lobe as sampling site (OR 2.15; 95% CI 1.13-4.11; p = 0.02) and more than 4 samples taken (OR 1.91; 95% CI 1.04-3.49; p = 0.04) to be significantly associated with PTX development.
CONCLUSIONS
We conclude that TBB from the left upper pulmonary lobe is associated with significantly increased risk of post-procedural PTX. The right lower pulmonary lobe seems to be the safest sampling site to perform TBB. In patients with diffuse-type pulmonary disease, TBB should be performed preferably from the right lower lobe in order to decrease the risk of post-procedural PTX.
背景
气胸（PTX）是经支气管镜活检（TBB）后最常见的并发症之一。既往研究提示，上肺叶 TBB 可能与 PTX 发生风险增加相关。本研究旨在比较不同肺叶 TBB 后 PTX 发生的风险。
方法
回顾性分析 2015 年 1 月 1 日至 2017 年 12 月 31 日（捷克布尔诺大学医院呼吸科）支气管镜检查记录。在 3542 例支气管镜检查记录中，796 例行 TBB 检查并进一步分析。分析基本人口统计学数据、TBB 操作相关因素、吸烟史和影像学特征。此外，对发生 PTX 的患者，分析 PTX 发病时间、PTX 症状、异常影像学表现分布和住院时间。
结果
发生 PTX 的患者 BMI 明显较低，且操作过程中取检标本数多于 4 个（均 P<0.05）。左肺上叶 TBB 与 PTX 发生风险显著相关（OR 2.27；95%CI 1.18-4.35；P=0.02）。相反，右肺下叶 TBB 与 PTX 发生风险显著降低相关（OR 0.47；95%CI 0.22-0.98；P=0.04）。Logistic 回归分析显示 BMI（OR 1.08；95%CI 1.02-1.16；P=0.01）、左肺上叶作为取样部位（OR 2.15；95%CI 1.13-4.11；P=0.02）和取检标本数多于 4 个（OR 1.91；95%CI 1.04-3.49；P=0.04）与 PTX 发生显著相关。
结论
我们认为，左肺上叶 TBB 后 PTX 发生风险显著增加。右肺下叶似乎是 TBB 操作最安全的取样部位。在弥漫性肺部疾病患者中，为降低 PTX 发生风险，TBB 应首选右肺下叶进行。
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