The effectiveness of the puncture channel plugging for reduction of complications after CT-guided percutaneous transthoracic needle biopsy

Abstract

The effect of plugging the puncture channel with a mixture of hemocoagulase injection on the complications of CT-guided percutaneous transthoracic need biopsy (PTNB) was discussed. The medical records of PTNB were retrospectively studied from June 2017 to May 2022. In the study, the puncture channel of 626 patients were blocked, while remain 681 patients' were not. The Mantel Haenszel method performed layered analysis and evaluated the correlation of adjusted confounding factors. The Odds Ratio and its 95% confidence interval were calculated using the Woof method. The incidence of high-level pulmonary hemorrhage was significantly reduced in patients with lesions ≤ 2 cm and different needle lengths. Patients with different pleural-needle tip angle and perineedle emphysema were blocked, and the incidence of pneumothorax and thoracic implants was significantly reduced. Through puncture channel plugging, the incidence of pulmonary hemorrhage, pneumothorax and thoracic catheterization of PTNB under CT guidance was reduced.

Figure 1

Schematic diagram of PTNB implementation steps: (a) After selecting the appropriate puncture point and needle path, CT scan is performed immediately as soon as the coaxial needle penetrates the extrapleura. (b) After adjusting the direction, the coaxial needle penetrates the edge of the lesion. (c) The needle core is taken out and it is put into the biopsy needle. (d) After obtaining the tissue, the tail of the coaxial needle is quickly plugged with the thumb. (e) The syringe containing the gelatin sponge slurry is connected. (f) Puncture channel plugging technique: immediately the coaxial needle is withdrawn the plugging material is injected into the pleura and lung parenchyma.

Figure 2

Preparation steps of gelatin sponge slurry: (a) The gelatin sponge is divided into three layers. (b) The gelatin sponge is cut into strips of 1–1.5 mm width. (c) The gelatin sponge is soaked in saline and rolled into a cylinder, and cut into a cube of 1–1.5 mm. (d) It is put into a 5 ml syringe and connected to a syringe with 1 mL of hemocoagulase injection through a three-way valve, and a flocculent gelatin sponge slurry is available after mixture.

Figure 3

Flow chart of patients enrolled in the study.

Figure 4

The process of plugging the puncture channel of a 64-year-old female patient: (a) The patient lies on the CT scan bed on her back, and a fence-like locator is placed on the skin surface. (b) The coaxial needle is punctured to the outside of the pleura. (c) After adjusting the direction, the coaxial needle reaches the edge of the nodule of the right upper lobe. (d) An 18G biopsy needle is inserted to cut the tissue. (e) When the coaxial needle is withdrawn, the plugging material is injected into the pleura and lung parenchyma, and the gelatin sponge slurry forms a striped shadow indicating high density. (f) The gelatin sponge slurry disappeared after 31 days, and the pathology report is lung adenocarcinoma.