Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland; Department of Radiology, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland.
Eur J Radiol. 2024 Jul;176:111529. doi: 10.1016/j.ejrad.2024.111529. Epub 2024 May 24.
This study investigated strategies to reduce pneumothorax risk in CT-guided lung biopsy. The approach involved administering 10 ml of 1 % lidocaine fluid in the subpleural or pleural space before lung puncture and utilizing the gravitational effect of pleural pressure with specific patient positioning.
We retrospectively analyzed 72 percutaneous CT-guided lung biopsies performed at a single center between January 2020 and April 2023. These were grouped based on fluid administration during the biopsy and whether the biopsies were conducted in dependent or non-dependent lung regions. Confounding factors like patient demographics, lesion characteristics, and procedural details were assessed. Patient characteristics and the occurrence of pneumothoraces were compared using a Kurskal-Wallis test for continuous variables and a Fisher's exact test for categorical variables. Multivariable logistic regression was used to identify potential confounders.
Subpleural or pleural fluid administration and performing biopsies in dependent lung areas were significantly linked to lower peri-interventional pneumothorax incidence (n = 15; 65 % without fluid in non-dependent areas, n = 5; 42 % without fluid in dependent areas, n = 5; 36 % with fluid in non-dependent areas,n = 0; 0 % with fluid in dependent areas; p = .001). Even after adjusting for various factors, biopsy in dependent areas and fluid administration remained independently associated with reduced pneumothorax risk (OR 0.071, p<=.01 for lesions with fluid administration; OR 0.077, p = .016 for lesions in dependent areas).
Pre-puncture fluid administration to the pleura and consideration of gravitational effects during patient positioning can effectively decrease pneumothorax occurrences in CT-guided lung biopsy.
本研究旨在探讨降低 CT 引导下肺活检气胸风险的策略。该方法包括在肺穿刺前向胸膜下或胸膜腔注入 10ml1%利多卡因液，并利用特定的患者体位使胸膜压力产生的重力效应。
我们回顾性分析了 2020 年 1 月至 2023 年 4 月在单一中心进行的 72 例经皮 CT 引导下肺活检。根据活检过程中是否给予液体及活检是否在独立或非独立肺区进行进行分组。评估了患者人口统计学特征、病变特征和操作细节等混杂因素。使用 Kruskal-Wallis 检验比较连续变量，Fisher 确切检验比较分类变量，比较患者特征和气胸的发生情况。使用多变量逻辑回归识别潜在混杂因素。
胸膜下或胸膜腔给予液体和在依赖肺区进行活检与较低的围介入性气胸发生率显著相关（无液体的非依赖区 n=15；65%，无液体的依赖区 n=5；42%，有液体的非依赖区 n=5；0%，有液体的依赖区 n=0；0%；p=0.001）。即使调整了各种因素，依赖区活检和液体给予仍与气胸风险降低独立相关（有液体给药时病变的 OR 0.071，p<=0.01；依赖区病变的 OR 0.077，p=0.016）。
在 CT 引导下肺活检前向胸膜腔注入液体，并在患者体位时考虑重力效应，可有效降低气胸发生率。
