Nakamura Megumi, Yoshizako Takeshi, Koyama Shingo, Kitagaki Hajime
Department of Radiology, Shimane University Faculty of Medicine, Izumo Department of Radiology, Yokosuka Kyosai Hospital, Yokosuka, Japan.
J Med Imaging Radiat Oncol. 2011 Oct;55(5):474-8. doi: 10.1111/j.1754-9485.2011.02283.x.
The purpose of this study was to evaluate the risk factors for developing a pneumothorax requiring chest tube placement in patients undergoing CT-guided needle biopsy of the lung.
In 150 patients, 156 CT-guided needle biopsies of the lung were performed. Patient age, position during biopsy, presence of emphysema, lesion size, depth and location, number of pleural punctures and pleural-puncture angle were analysed as independent risk factors for chest tube placement for pneumothorax.
Pneumothorax occurred in 93 of 156 procedures (59.6%), and chest tube placement was required in 12 cases (7.7% of all biopsies, 12.9% of all pneumothoraces). Among patients with a pneumothorax, the proportion of cases biopsied in the supine position was significantly greater in the chest tube placement group (58.3%; 7/12) than in the nonchest tube placement group (28.4%; 23/81) (P=0.026). Patient age, presence of emphysema, lesion size, needle path length, location of pulmonary lesions, number of pleural punctures and the smallest angle between the pleura and the needle showed no significant differences between the two groups.
Chest tube insertion was required more frequently in patients biopsied in the supine versus prone position. The prone position is considered preferable to reduce the risk of significant pneumothorax requiring chest tube insertion.
本研究的目的是评估在接受CT引导下肺穿刺活检的患者中，发生需要放置胸管的气胸的危险因素。
对150例患者进行了156次CT引导下的肺穿刺活检。分析患者年龄、活检时的体位、肺气肿的存在情况、病变大小、深度和位置、胸膜穿刺次数及胸膜穿刺角度，将其作为放置胸管治疗气胸的独立危险因素。
156例操作中有93例（59.6%）发生气胸，其中12例（占所有活检的7.7%，占所有气胸的12.9%）需要放置胸管。在气胸患者中，胸管放置组仰卧位活检的比例（58.3%；7/12）显著高于非胸管放置组（28.4%；23/81）（P = 0.026）。两组患者的年龄、肺气肿的存在情况、病变大小、针道长度、肺部病变位置、胸膜穿刺次数以及胸膜与针之间的最小角度无显著差异。
仰卧位活检的患者比俯卧位活检的患者更频繁地需要插入胸管。俯卧位被认为更可取，以降低发生需要插入胸管的严重气胸的风险。
