Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Okayama 700-8558, Japan.
AJR Am J Roentgenol. 2010 Mar;194(3):809-14. doi: 10.2214/AJR.09.3224.
The objective of our study was to retrospectively evaluate the incidence of and the risk factors for pneumothorax and chest tube placement after CT fluoroscopy-guided lung biopsy.
We analyzed 1,098 CT fluoroscopy-guided lung biopsies conducted with 20-gauge coaxial cutting needles for 1,155 lesions in 1,033 patients. Apart from evaluating the incidence of pneumothorax and chest tube placement, the independent risk factors for pneumothorax and chest tube placement for pneumothorax were determined using multivariate logistic regression analysis.
The overall incidence of pneumothorax was 42.3% (464/1,098). Chest tube placement was required for 11.9% (55/464) of pneumothoraces (5.0% [55/1,098] of the total number of procedures). The significant independent risk factors for pneumothorax were no prior pulmonary surgery (p = 0.001), lesions in the lower lobe (p < 0.001), greater lesion depth (p < 0.001), and a needle trajectory angle of < 45 degrees (p = 0.014); those for chest tube placement for pneumothorax were pulmonary emphysema (p < 0.001) and greater lesion depth (p < 0.001).
Pneumothorax frequently occurred and placement of a chest tube was occasionally required for pneumothorax after CT fluoroscopy-guided lung biopsy. To reduce the risk of pneumothorax necessitating chest tube placement, physicians should adopt the shortest needle path to the lesion.
本研究旨在回顾性评估 CT 透视引导下肺活检后气胸和放置胸腔引流管的发生率和危险因素。
我们分析了 1033 例患者 1155 个病灶接受 20G 同轴切割针 CT 透视引导下肺活检的结果。除评估气胸和胸腔引流管放置的发生率外，还采用多变量逻辑回归分析确定气胸和胸腔引流管放置的独立危险因素。
气胸总发生率为 42.3%（464/1098）。气胸需放置胸腔引流管的比例为 11.9%（55/464）（总操作的 5.0%[55/1098]）。气胸的独立危险因素为无既往肺部手术史（p = 0.001）、下叶病变（p < 0.001）、病变深度较大（p < 0.001）和针轨迹角度<45 度（p = 0.014）；气胸放置胸腔引流管的独立危险因素为肺气肿（p < 0.001）和病变深度较大（p < 0.001）。
CT 透视引导下肺活检后气胸发生率较高，气胸时需偶尔放置胸腔引流管。为降低气胸需放置胸腔引流管的风险，医生应采用最短的进针路径到达病灶。
