Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: Incidence and risk factors
Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: Incidence and risk factors
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DOI：
10.2214/ajr.172.4.10587145
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发表时间：
1999-04-01
影响因子：
5
通讯作者：
Marthan, R
中科院分区：
文献类型：
--
作者：
Laurent, F;Michel, P;Marthan, R
OBJECTIVE.本研究探讨了影响使用同轴技术进行CT引导下经皮肺活检的肺部病变患者气胸和胸管放置风险的因素。该研究包括307例在CT引导下进行肺病变活检的患者。考虑的患者相关参数包括年龄、性别、是否存在肺气肿或肺大疱以及肺功能数据。病变相关变量包括大小、位置、CT上的空洞外观、胸膜接触和病变深度。手术变量为持续时间、针头类型和操作者经验。所有变量均作为气胸发生率的单因变量和多因变量进行分析。307例患者中有61例（19.9%）发生气胸，6例患者（2.0%）需要放置胸管。单因素分析显示，病变大小、病变位置、病变深度和手术难度与气胸发生率较高显著相关。使用多变量逻辑回归分析，我们发现胸膜进入点的病变深度是与气胸风险增加显著相关的唯一变量。这种风险随着病变的深度而增加。严重肺气肿、阻塞性肺疾病或过度充气的患者更需要放置胸管。病变深度是CT引导下经皮肺活检患者发生气胸的主要危险因素。在严重肺气肿、阻塞性肺病或肺过度充气的患者中，更经常需要放置胸管。
OBJECTIVE. This study investigates factors influencing the risk of pneumothorax and chest tube placement in patients undergoing CT-guided transthoracic lung biopsy for pulmonary lesions using a coaxial technique.SUBJECTS AND METHODS. The study included 307 patients with pulmonary lesions biopsied under CT guidance. Patient-related parameters considered were age, sex, presence of emphysema or bullae, and lungs function data. Lesion-related variables were size, location, cavitary appearance on CT, pleural contact, and depth of the lesion. Procedure variables were duration, type of needle, and experience of the operator. All variables were analyzed as single and multiple dependent variables for occurrence of pneumothorax.RESULTS. Pneumothorax occurred in 61 (19.9%) of the 307 patients, and chest tube placement was required in six patients (2.0%). Univariate analysis showed that lesion size, lesion location, lesion depth, and difficulty of the procedure were significantly associated with a higher rate of pneumothorax. Using multivariate logistic regression analysis, we found that lesion depth from the pleural entry point was the sole variable that was significantly associated with an increased risk of pneumothorax. This risk increased with the depth of the lesion. Chest tube placement was required more frequently in patients with severe emphysema, obstructive lung disease, or hyperinflation.CONCLUSION. Lesion depth is the predominant risk factor for pneumothorax in patients undergoing CT-guided transthoracic lung biopsy. Chest tube placement is necessary more frequently in patients with severe emphysema, obstructive lung disease, or hyperinflation.