Department of Diagnostic Radiology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
AJR Am J Roentgenol. 2013 Jun;200(6):1238-43. doi: 10.2214/AJR.12.8980.
The purpose of this study was to determine whether an autologous intraparenchymal blood patch reduces the rate of pneumothorax and the rate of pneumothorax requiring chest tube placement after percutaneous lung biopsy.
A prospective randomized controlled trial enrolling 242 patients was conducted. Adult patients undergoing percutaneous biopsy of lung or mediastinal lesions of undetermined cause were candidates. Patients were excluded if aerated lung tissue was not crossed during the biopsy. A standard biopsy procedure was followed for all patients until an adequate tissue sample was obtained. Patients were then randomized. For patients randomized to the treatment group, an intraparenchymal blood patch was administered through the guiding needle on removal. The same postbiopsy procedures were followed for both the treatment and control groups. Data collected included development of pneumothorax and placement of a chest tube.
The rate of pneumothorax was reduced from 35% to 26% (p = 0.12) with the use of the blood patch, but the reduction was not significant. The rate of pneumothorax requiring chest tube placement was significantly reduced from 18% to 9% (p = 0.048). There was a greater benefit in the blood patch group when a 19-gauge guiding needle was used: Pneumothorax requiring chest tube placement was reduced from 19% to 3% whereas an increase from 16% to 20% was seen with a 17-gauge needle (p = 0.029).
The use of an autologous intraparenchymal blood patch significantly reduces the rate of pneumothorax requiring chest tube placement. It seems to be more beneficial when a 19-gauge guiding needle is used.
本研究旨在确定自体肺内血补丁是否能降低经皮肺活检后气胸的发生率和需要放置胸腔引流管的气胸发生率。
进行了一项前瞻性随机对照试验，共纳入 242 名患者。纳入标准为接受经皮肺或纵隔不明原因病变活检的成年患者。如果活检过程中未穿过充气肺组织，则排除患者。所有患者均遵循标准活检程序，直至获得足够的组织样本。然后对患者进行随机分组。对于随机分组到治疗组的患者，在移除引导针时通过引导针注入肺内血补丁。治疗组和对照组均遵循相同的活检后程序。收集的数据包括气胸的发生和胸腔引流管的放置情况。
使用血补丁后，气胸发生率从 35%降至 26%（p=0.12），但差异无统计学意义。气胸需要放置胸腔引流管的发生率从 18%显著降至 9%（p=0.048）。使用 19 号引导针时，血补丁的效果更为显著：需要放置胸腔引流管的气胸发生率从 19%降至 3%，而使用 17 号引导针时，气胸发生率从 16%升至 20%（p=0.029）。
使用自体肺内血补丁可显著降低需要放置胸腔引流管的气胸发生率。当使用 19 号引导针时，效果似乎更为显著。
