Kuban Joshua D, Tam Alda L, Huang Steven Y, Ensor Joe E, Philip Asher S, Chen Geraldine J, Ahrar Judy, Murthy Ravi, Avritscher Rony, Madoff David C, Mahvash Armeen, Ahrar Kamran, Wallace Michael J, Nachiappan Arun C, Gupta Sanjay
Department of Radiology, Baylor College of Medicine, Mailstop 360, Houston, TX, 77030, USA.
Unit 1471, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, PO Box 301402, Houston, TX, 77230-1402, USA.
Cardiovasc Intervent Radiol. 2015 Dec;38(6):1595-602. doi: 10.1007/s00270-015-1097-0. Epub 2015 Apr 30.
The aim of this study was to evaluate the effect of coaxial guide needle gauge (18 vs. 19 gauge) on the risk of pneumothorax and chest tube placement after CT-guided lung biopsy.
Imaging records of all patients who had undergone CT-guided lung biopsies at our institution from March 1, 2006 to December 9, 2010 were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed to assess the effect of various patient-, lesion-, and procedure-related variables on subsequent pneumothorax and chest tube placement rates.
The study included 4262 biopsies (2304 with 18-gauge and 1958 with 19-gauge coaxial guide needles) in 3917 patients. The rates of pneumothorax and chest tube placement were 30.2 and 15%, respectively. Pneumothorax occurred in 35% of procedures performed with 18-gauge needles and in 24.5% of procedures performed with 19-gauge needles (p < 0.0001). Chest tube insertion occurred in 16.7% of procedures performed with 18-gauge needles and in 13.1% of procedures performed with 19-gauge needles (p = 0.0011). Multivariate logistic regression models demonstrated that the use of an 18-gauge needle was associated with a higher rate of pneumothorax (p < 0.0001) and chest tube placement (p = 0.0003). The following factors were also associated with higher rates of pneumothorax and chest tube placement: older age, emphysema, greater number of pleural surfaces crossed, and a longer biopsy needle path length.
The use of a 19-gauge coaxial guide needle significantly decreases the risk of pneumothorax and chest tube placement compared with an 18-guage needle.
本研究的目的是评估同轴引导针规格（18G与19G）对CT引导下肺活检后气胸风险及胸腔置管的影响。
回顾性分析2006年3月1日至2010年12月9日在我院接受CT引导下肺活检的所有患者的影像记录。进行单因素和多因素逻辑回归分析，以评估各种患者、病变和操作相关变量对随后气胸和胸腔置管率的影响。
该研究纳入了3917例患者的4262次活检（2304次使用18G同轴引导针，1958次使用19G同轴引导针）。气胸率和胸腔置管率分别为30.2%和15%。使用18G针进行的操作中气胸发生率为35%，使用19G针进行的操作中气胸发生率为24.5%（p<0.0001）。使用18G针进行的操作中胸腔置管发生率为16.7%，使用19G针进行的操作中胸腔置管发生率为13.1%（p=0.0011）。多因素逻辑回归模型表明，使用18G针与较高的气胸率（p<0.0001）和胸腔置管率（p=0.0003）相关。以下因素也与较高的气胸率和胸腔置管率相关：年龄较大、肺气肿、穿过的胸膜面数量较多以及活检针路径长度较长。
与18G针相比，使用19G同轴引导针可显著降低气胸和胸腔置管的风险。
