NSW Health, Bankstown-Campbelltown Hospital, Sydney, Australia.
Department of Radiology, Concord Repatriation General Hospital, Sydney, Australia.
Cardiovasc Intervent Radiol. 2019 Aug;42(8):1062-1072. doi: 10.1007/s00270-019-02196-8. Epub 2019 Mar 12.
This systematic review and meta-analysis investigated post-biopsy manoeuvres to reduce pneumothorax following computed tomography-guided percutaneous transthoracic lung biopsy. Twenty-one articles were included with 7080 patients. Chest drain insertion rates were significantly reduced by ninefold with the normal saline tract sealant compared to controls (OR 0.11, 95% CI 0.02-0.48), threefold with the rapid rollover manoeuvre to puncture site down (OR 0.34, 95% CI 0.18-0.63), threefold with the tract plug (OR 0.33, 95% CI 0.22-0.48) and threefold with the blood patch (OR 0.39, 95% CI 0.26-0.58). The absolute chest drain insertion rates were the lowest in the normal saline tract sealant (0.8% vs 7.3% for controls), rapid rollover (1.9% vs 5.2%), deep expiration and breath-hold on needle extraction (0.9% vs 1.8%) and standard rollover versus no rollover (2.6% vs 5.2%). These findings highlight post-biopsy manoeuvres which could help reduce pneumothorax and chest drain insertions following lung biopsies. LEVEL OF EVIDENCE: Level 1/no level of evidence, systematic review.
本系统评价和荟萃分析研究了计算机断层扫描引导经皮经胸肺活检后减少气胸的活检后操作。共纳入 21 篇文章，涉及 7080 例患者。与对照组相比，生理盐水通道密封剂可使胸腔引流管插入率显著降低 9 倍（OR 0.11，95%CI 0.02-0.48），快速翻转穿刺点向下的操作可使胸腔引流管插入率降低 3 倍（OR 0.34，95%CI 0.18-0.63），通道塞可使胸腔引流管插入率降低 3 倍（OR 0.33，95%CI 0.22-0.48），血补丁可使胸腔引流管插入率降低 3 倍（OR 0.39，95%CI 0.26-0.58）。生理盐水通道密封剂的绝对胸腔引流管插入率最低（0.8%比对照组的 7.3%），快速翻转（1.9%比 5.2%），深呼气和针拔时屏住呼吸（0.9%比 1.8%），标准翻转与无翻转（2.6%比 5.2%）。这些发现强调了活检后的操作，这些操作可以帮助减少肺活检后的气胸和胸腔引流管插入。证据水平：1 级/无证据水平，系统评价。
