Factors influencing pneumothorax rate at lung biopsy: Are dwell time and angle of pleural puncture contributing factors?
Factors influencing pneumothorax rate at lung biopsy: Are dwell time and angle of pleural puncture contributing factors?
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DOI：
10.1148/radiology.218.2.r01fe33491
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发表时间：
2001-02-01
期刊：
影响因子：
19.7
通讯作者：
McLoud, TC
中科院分区：
文献类型：
--
作者：
Ko, JP;Shepard, JAO;McLoud, TC
目的：探讨影响气胸胸管置入率的因素，尤其是针停留时间和胸膜穿刺角度。材料与方法：对159例患者进行了160例同轴计算机断层扫描（CT）引导下的肺活检。计算停留时间，即胸膜穿刺至取针之间的时间。测量针与胸膜的最小夹角（“针-胸膜角”）。这些和其他变量与气胸和胸管率相关。结果：纳入150例活组织检查。58例（39%）气胸（14例仅在CT上发现），8例（5%）活检导致胸管置入。较长的停留时间（平均29分钟，范围12-66分钟）与气胸无关（P = 0.81）。针胸膜夹角较小（80度）、1秒内用力呼气量与肺活量之比减小（< 50%）、侧边胸膜穿刺和沿裂隙病变与气胸发生率降低相关（P < 0.05）。针路沿线的肺气肿、肺功能检查显示通气阻塞和裂隙沿线的病变倾向于患者放置胸管（P < 0.05）。胸膜增厚和既往手术与气胸发生率较低相关（P < 0.05）。结论：较长的停留时间与气胸无关，不应影响获得更多活检样本的决定。浅胸膜穿刺角度可增加气胸发生率。
PURPOSE: To study factors that may influence pneumothorax and chest tube placement rate, especially needle dwell time and pleural puncture angle.MATERIALS AND METHODS: In 159 patients, 160 coaxial computed tomography (CT)-guided lung biopsies were performed. Dwell time, the time between pleural puncture and needle removal, was calculated. The smallest angle of the needle with the pleura ("needle-pleural angle") was measured. These and other variables were correlated with pneumothorax and chest tube rates.RESULTS: One hundred fifty biopsies were included. There were 58 (39%) pneumothoraces (14 noted only at CT), with eight (5%) biopsies resulting in chest tube placement. Longer dwell times (mean, 29 minutes; range, 12-66 minutes) did not correlate with pneumothoraces (P = .81). Smaller needle-pleural angles (80 degrees), decreased forced expiratory volume in 1 second to vital capacity ratio (< 50%), lateral pleural puncture, and lesions along fissures were associated with lower pneumothorax rates (P < .05). Emphysema along the needle path, pulmonary function tests showing ventilatory obstruction, and lesions along fissures predisposed patients to chest tube placement (P < .05). Pleural thickening and prior surgery were associated with lower pneumothorax rates (P < .05).CONCLUSION: Longer dwell times do not correlate with pneumothorax and should not influence the decision to obtain more biopsy samples. A shallow pleural puncture angle may increase the pneumothorax rate.