胸膜外生理盐水水分离在CT引导肺活检中减少气胸的前瞻性对照研究
该前瞻性对照研究纳入90例距胸膜≤1.5 cm的肺病变患者，比较标准CT引导经皮穿刺活检与联合胸膜外生理盐水水分离（EPSH）两种方法。结果显示EPSH组气胸发生率显著降低（8.9% vs 26.7%，p=0.027），绝对风险降低17.8%，需治疗人数为6，但手术时间、辐射剂量和CT采集次数增加，对距胸膜≤5 mm病变获益最大。
要点
- 对距胸膜≤1.5 cm的肺病变，EPSH可显著降低CT引导活检后气胸发生率。
- EPSH增加手术时间、辐射剂量和CT采集次数，但均无严重并发症需干预。
- 距胸膜≤5 mm的病变从EPSH中获益最大，可最大限度减少穿刺路径上的含气肺组织。
关键影像表现/征象
- EPSH组气胸发生率为8.9%，标准PTNB组为26.7%（p=0.027）。
- EPSH组手术时间（23.4±4.4 min）、辐射剂量（124.6±44.5 mGy·cm）和CT采集次数（6.0±1.4）均高于标准组（分别为16.9±4.5 min、105.7±41.5 mGy·cm、5.2±1.4），所有p≤0.015。
- EPSH显著缩短了所有亚组中胸膜-病变距离（p<0.05），对距胸膜≤5 mm的病变可最大限度减少含气肺组织。
- 标准PTNB组气胸风险高于EPSH组（OR 4.68，95% CI 1.24-17.65；p=0.023）。
- 两组均无气胸需要干预。
诊断标准与关键数值
- 气胸发生率：EPSH组8.9% vs 标准组26.7%，绝对风险降低17.8%，需治疗人数为6。
- 多因素logistic回归：标准PTNB组气胸OR为4.68（95% CI 1.24-17.65；p=0.023）。
- 病变按胸膜-病变距离分层：≤5 mm、>5-10 mm、>10-15 mm，EPSH后距离均显著缩短（p<0.05）。
临床应用与阅片要点
- 对于距胸膜≤1.5 cm的肺病变，可考虑在CT引导活检前进行EPSH以降低气胸风险。
- 距胸膜≤5 mm的病变从EPSH中获益最大，可优先考虑该技术。
- 需权衡EPSH增加的手术时间、辐射剂量和CT采集次数与气胸风险降低的获益。
局限性
- 研究为单中心前瞻性设计，样本量有限（90例），结论外推需谨慎。
- 原文未报告随机化方法及盲法情况。
- 未报告长期随访或成本效益分析。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: To evaluate whether extrapleural saline hydrodissection (EPSH) performed before CT-guided percutaneous transthoracic needle biopsy (PTNB) reduces pneumothorax in pleura-adjacent lung lesions.
METHODS: In this prospective study, 90 patients with pulmonary lesions ≤1.5 cm from the pleura underwent CT-guided PTNB and were assigned to standard PTNB (Group 1, n = 45) or PTNB with EPSH (Group 2, n = 45). Demographic, lesion-related, procedural variables and complications were compared. Multivariable logistic regression evaluated the effect of EPSH on pneumothorax. In Group 2, lesions were stratified by pleura-lesion distance (≤5 mm, >5-10 mm, >10-15 mm); pre- and post-EPSH distances were compared.
RESULTS: Procedure time (16.9 ± 4.5 vs. 23.4 ± 4.4 min), radiation dose (105.7 ± 41.5 vs. 124.6 ± 44.5 mGy·cm), and CT acquisitions (5.2 ± 1.4 vs. 6.0 ± 1.4) were higher in Group 2 (all p ≤ 0.015). Pneumothorax was less frequent after EPSH-assisted PTNB (26.7% vs. 8.9%, p = 0.027), corresponding to an absolute risk reduction 17.8% and number needed to treat of 6; none required intervention. Group 1 showed higher pneumothorax odds than Group 2 (OR 4.68, 95% CI 1.24-17.65; p = 0.023). Other procedural parameters were similar. EPSH significantly reduced pleura-lesion distance in all subgroups (p < 0.05), minimizing aerated lung in lesions ≤5 mm.
CONCLUSION: EPSH was associated with significantly lower pneumothorax rates during CT-guided PTNB despite increased procedural demands, with greatest benefit in lesions ≤5 mm from the pleura.
引用
- Alver KH, Arslan M, Kurnaz B, et al. Extrapleural Saline Hydrodissection Before CT-Guided Lung Biopsy to Reduce Pneumothorax: A Prospective Comparative Study in Pleura-Adjacent Lesions. Acad Radiol. 2026. PMID: 42070962. doi:10.1016/j.acra.2026.04.022
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。