Yamagami T, Terayama K, Yoshimatsu R, Matsumoto T, Miura H, Nishimura T
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo, Kyoto, Japan.
Acta Radiol. 2009 Dec;50(10):1126-33. doi: 10.3109/02841850903232707.
Pneumothorax is the most common complication after computed tomography (CT)-guided lung biopsy. The presence of a pneumothorax per se does not complicate patient management, but an increasing pneumothorax, making chest tube placement necessary, is highly problematic.
To evaluate the efficacy and limitations of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following CT-guided lung biopsy.
The subjects of our study were 642 consecutive lung lesions in 594 patients for which percutaneous needle lung biopsies were performed using CT guidance. While patients were on the CT scanner table, percutaneous manual aspiration was performed in all patients with a non-small pneumothorax demonstrated on post-biopsy chest CT images. The frequency of pneumothorax, management of each such case, and factors influencing the incidence of worsening pneumothorax that finally required chest tube placement were evaluated.
Post-biopsy pneumothorax occurred in 243 of 642 (38%) procedures. Of the 243 cases, 112 were treated with manual aspiration immediately after biopsy. In 210 (86.4%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement. Only 33 patients required chest tube placement. Requirement of chest tube insertion significantly increased in parallel with the degree of pneumothorax as shown on post-biopsy CT images. The rate of chest tube insertion was statistically higher in subjects with values for aspirated air above 543 ml.
Percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent worsening of pneumothorax and avoid chest tube placement. The amount of aspirated air can be predictive of the requirement for chest tube placement.
气胸是计算机断层扫描（CT）引导下肺活检后最常见的并发症。气胸本身并不使患者管理复杂化，但气胸加重导致需要放置胸腔引流管则是个大问题。
评估单纯从胸膜腔抽气以预防气胸加重并避免在CT引导下肺活检后发生气胸时放置胸腔引流管的疗效和局限性。
我们的研究对象为594例患者的642个连续肺部病变，这些病变均在CT引导下进行经皮针吸肺活检。当患者在CT扫描台上时，对活检后胸部CT图像显示有非小量气胸的所有患者进行经皮手动抽气。评估气胸的发生率、每个病例的处理方式以及影响最终需要放置胸腔引流管的气胸恶化发生率的因素。
642例手术中有243例（38%）术后发生气胸。在这243例病例中，112例在活检后立即进行了手动抽气治疗。在210例（86.4%）中，气胸在后续胸部X线片上完全吸收，无需放置胸腔引流管。只有33例患者需要放置胸腔引流管。如活检后CT图像所示，胸腔引流管置入的需求随着气胸程度的加重而显著增加。抽气超过543 ml的患者胸腔引流管置入率在统计学上更高。
活检后立即进行经皮手动抽吸活检引起的气胸可预防气胸恶化并避免放置胸腔引流管。抽气量可预测胸腔引流管的放置需求。
