Kakizawa Hideaki, Toyota Naoyuki, Hieda Masashi, Hirai Nobuhiko, Tachikake Toshihiro, Matsuura Noriaki, Oda Miyo, Ito Katsuhide
Department of Diagnostic Radiology, Hiroshima University Hospital, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima 734-8551, Japan.
Hiroshima J Med Sci. 2010 Sep;59(3):43-50.
The purpose of this study is to evaluate the risk factors for the severity of pneumothorax after computed tomography (CT)-guided percutaneous lung biopsy using the single-needle method. We reviewed 91 biopsy procedures for 90 intrapulmonary lesions in 89 patients. Patient factors were age, sex, history of ipsilateral lung surgery and grade of emphysema. Lesion factors were size, location and pleural contact. Procedure factors were position, needle type, needle size, number of pleural punctures, pleural angle, length of needle passes in the aerated lung and number of harvesting samples. The severity of pneumothorax after biopsy was classified into 4 groups: "none", "mild", "moderate" and "severe". The risk factors for the severity of pneumothorax were determined by multivariate analyzing of the factors derived from univariate analysis. Pneumothorax occurred in 39 (43%) of the 91 procedures. Mild, moderate, and severe pneumothorax occurred in 24 (26%), 8 (9%) and 7 (8%) of all procedures, respectively. Multivariate analysis showed that location, pleural contact, number of pleural punctures and number of harvesting samples were significantly associated with the severity of pneumothorax (p < 0.05). In conclusion, lower locations and non-pleural contact lesions, increased number of pleural punctures and increased number of harvesting samples presented a higher severity of pneumothorax.
本研究的目的是评估采用单针技术在计算机断层扫描（CT）引导下经皮肺活检后气胸严重程度的危险因素。我们回顾了89例患者90个肺内病变的91例活检操作。患者因素包括年龄、性别、同侧肺部手术史和肺气肿分级。病变因素包括大小、位置和胸膜接触情况。操作因素包括体位、针型、针的大小、胸膜穿刺次数、胸膜角度、在充气肺内进针长度和取材样本数量。活检后气胸的严重程度分为4组：“无”、“轻度”、“中度”和“重度”。通过对单因素分析得出的因素进行多因素分析来确定气胸严重程度的危险因素。91例操作中有39例（43%）发生气胸。轻度、中度和重度气胸分别发生在所有操作的24例（26%）、8例（9%）和7例（8%）。多因素分析显示，病变位置、胸膜接触情况、胸膜穿刺次数和取材样本数量与气胸严重程度显著相关（p<0.05）。总之，病变位置较低且与胸膜无接触、胸膜穿刺次数增加以及取材样本数量增加时，气胸严重程度更高。
