Department of Radiology, University of Wisconsin, Madison, Wisconsin.
Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin.
J Vasc Interv Radiol. 2021 Sep;32(9):1319-1327. doi: 10.1016/j.jvir.2021.06.022. Epub 2021 Jul 3.
To evaluate the outcomes of computed tomography (CT) fluoroscopy-guided core lung biopsies with emphasis on diagnostic yield, complications, and efficacy of parenchymal and pleural blood patching to avoid chest tube placement.
This is a single-center retrospective analysis of CT fluoroscopy-guided percutaneous core lung biopsies between 2006 and 2020. Parenchymal blood patching during introducer needle withdrawal was performed in 74% of cases as a preventive measure, and pleural blood patching was the primary salvage maneuver for symptomatic or growing pneumothorax in 60 of 83 (72.2%) applicable cases.
A total of 1,029 patients underwent 1,112 biopsies (532 men; mean age, 66 years; 38.6%, history of emphysema; lesion size, 16.7 mm). The diagnostic yield was 93.6% (1,032/1,103). Fewer complications requiring intervention were observed in patients who underwent parenchymal blood patching (5.7% vs 14.2%, P < .001). Further intervention was required in 83 of 182 pneumothorax cases, which included the following: (a) pleural blood patch (5.4%, 60/1,112), (b) chest tube placement without a pleural blood patch attempt (1.5%, 17/1,112), and (c) simple aspiration (0.5%, 6/1,112). Pleural blood patch as monotherapy was successful in 83.3% (50/60) of cases without need for further intervention. The overall chest tube rate was 2.6% (29/1,112). Emphysema was the only significant risk factor for complications requiring intervention (P ≤ .001).
Parenchymal blood patching during introducer needle withdrawal decreased complications requiring intervention. Salvage pleural blood patching reduced the frequency of chest tube placement for pneumothorax.
评估 CT 透视引导下经皮肺活检的结果，重点关注诊断率、并发症以及实施肺实质和胸膜血贴补术以避免放置胸腔引流管的效果。
这是一项 2006 年至 2020 年间 CT 透视引导下经皮肺活检的单中心回顾性分析。74%的病例在引入针退出时进行肺实质血贴补术作为预防措施，60/83（72.2%）适用病例中，胸膜血贴补术是针对症状性或进行性气胸的主要抢救措施。
共有 1029 名患者接受了 1112 次活检（532 名男性；平均年龄 66 岁；38.6%有肺气肿病史；病变大小 16.7 毫米）。诊断率为 93.6%（1032/1103）。进行肺实质血贴补术的患者并发症需要干预的情况较少（5.7%比 14.2%，P<0.001）。182 例气胸病例中需要进一步干预，包括以下内容：（a）胸膜血贴补术（5.4%，60/1112）；（b）未尝试胸膜血贴补术而放置胸腔引流管（1.5%，17/1112）；（c）单纯抽吸（0.5%，6/1112）。胸膜血贴补术作为单一疗法成功治疗了 83.3%（50/60）的病例，无需进一步干预。总的胸腔引流管率为 2.6%（29/1112）。肺气肿是需要干预的并发症的唯一显著危险因素（P≤0.001）。
引入针退出时进行肺实质血贴补术可减少需要干预的并发症。抢救性胸膜血贴补术降低了气胸放置胸腔引流管的频率。
