The Security And Effectivity About Pleural Biopsy On Diaphragm Of The Forceps-style Pleural Biopsy Trocar

Pleural effusion is clinical manifestation of systemic disease and diseasesof the pleura which is the first cause to see the doctor. A pleural biopsy shouldbe considered first in patients who have a pleural effusion of unknown causeafter initial investigations. Pathology evidence gaining from pleural biopsy isgold standard to pleural diseases.Closed pleural biopsy is a widely usedoperation with less trauma,easy to manipulate and handle, less pain forpatients, and economics. Abrams and Cope needles become the most widelyused device which gain specimen limited and with low positive rate. Toimprove the positive biopsy rate,we change the material and structural design,then design an effective and reliable pleural biopsy instrument, namely theforceps-style pleural biopsy trocar, which is cheap、safe and practical andsimple in structure and easy to operate. By comparing with cope needles, weperformed a series of experiments to approach its therapeutic effect and itssafety on animals for supplying fundamental theoretical basis for expandingclinical application.Objective: To evaluate the safety and effectiveness of the forceps-stylepleural biopsy trocar through the comparison of diaphragmatic pleural biopsyin experimental animals with the forceps-style pleural biopsy trocar andparietal pleura with Cope needle.Methods: The experiment selected12local healthy adult dogs, of eithersex, weighing16～20kg, the average was(18.2±3.1)kg, aged25～30months,the average (28.6±4.5) months. the dogs were randomly separated intotwo groups, each6dogs, which were raised and observed lively, healthywithout exception for two weekes in the Experimental Animal Center afterpurchasing. therefore all animals were included in the experiment. Experi- mental groups: performing the biopsy with the forceps-style pleural biopsytrocar on diaphragma; the control group:application Cope needle biopsy of theparietal pleura.We performed the biopsy with the pleural biopsy forceps on diaphragmaand Cope needle biopsy of the parietal pleura after establishing artificialmodel pleural effusion which breath sounds disappear and B-mode ultrasonicshow a large artificial pleural effusion pleural effusion modeling success.Experimental group: Select axillary line7-8or posterior axillary line8to9points as pleural biopsy puncture and perform the biopsy with the forceps-style pleural biopsy trocar on diaphragma on the edge of the ribs. Everythoracentesis allow to bite only three times and not to bite again withoutobtaining pleural tissue. Every dog was punctured8times,bited24times,alldog totally were48of thoracentesis, biting seized144times. Remove thepleural tissue specimens placed with a number fixed in10%formalin solutionand send to examine. To perform pleural biopsy on the contralateral chest ofeach animal after five days.Control group: Select axillary line7-8or posterior axillary line8to9points as pleural biopsy puncture and perform parietal pleural biopsy withCope needle on the edge of the ribs. Every thoracentesis pleural hook seizedonly three times (each puncture ticked3times, respectively,3,6,9points).Remove the pleural tissue specimens placed with a number fixed in10%formalin solution and send to examine.Every dog was punctured8times,bited24times,all dog totally were48of thoracentesis, biting seized144times. Toperform pleural biopsy on the contralateral chest of each animal after fivedays.Compare pleural biopsy success rates, drawing success rate, the volumeof tissue specimens and evaluated the incidence of complications between thetwo groups pleural biopsy and evaluate efficacy and safety; using SPSSversion13.0statistical software for statistical analysis.Results:1The result of the obtained pleural tissues Two groups of dogs each punctured48times, the success rate ofexperimental group thoracentesis was94%(45/48), the control group was56%(27/48), comparing the two groups have statistically significant difference(P<0.01); two groups bite or hook seized seized144times each, the successrate of the experimental group pleura was76%(110/144), the success rate ofthe control group was32%(46/144), the two groups was statisticallysignificant difference (P <0.01). The pleural tissues size of experimental groupwas2.6～26mm3, average(7.1±1.4)mm3. the size of the control group was1.6～28mm3,mean(7.4±1.3)mm3. There was no significant statisticaldifference in the obtained pleural tissues average size between the two groups（P>0.05）.2ComplicationsExperimental group perform thoracentesis for48times,the incidence ofiatrogenic pneumothorax was7cases, lung compression was≤5%; pleuralhemorrhage was6cases.The cases of iatrogenic pneumothorax in controlgroup was12times（P<0.05）, pleural hemorrhage was16cases(P<0.05). Twogroups had no dead animals.Conclusion:1The success rate of thoracentesis was94%(45/48) in experimentalgroup and56%(27/48) in control group. there was significant statisticaldifference in success rate(P<0.01).We can conclusion that the forceps-stylepleural biopsy trocar had more chance to gain pleural tissue than Cope needle.2The control group performed pleural biopsy144times, taken46timessuccessful, the sucess rate of obtaining pleural tissues was32%; Experimentalgroup performed pleural biopsy144times, taken110times successful, thesuccess rate of obtaining pleural tissues was76%. there was significantstatistical difference in obtaining pleural tissues(P<0.01).It showed that theforceps-style pleural biopsy trocar having less chances of obtaining muscletissue and fibrous tissue and biting empty was superior than Cope needle forgaining pleural tissues.3The pleural tissues size of experimental group was2.6～26mm3, average(7.1±1.4)mm3. the size of the control group was1.6～28mm3,mean(7.4±1.3)mm3. There was no significant statistical difference in the obtainedpleural tissues average size between the two groups(P>0.05). However, thelarger tissues were triated muscle tissue and small pleural tissue or evenmissing in control group, indicating that the Cope needle was not suitable formeager pleural.The experimental group showed greater tissue blocks weremainly pleural tissue, suggesting the forceps-style pleural biopsy trocar notonly bulky, but also more suitable for meager pleural and thickening obviouscases.4The forceps-style pleural biopsy trocar bited not only the parietal pleura,visceral pleura also seized bite, even diaphragmatic pleura, which broaden thescope of pleural biopsy and significantly improved the success rate.5Compared with Cope needle, forceps-style pleural biopsy trocar bitedetection techniques require low, the operation more simple, cbetter comp-liance, considerably reduced the physician to operate technology-dependent.6The incidence of pneumothorax experimental group was14.5%lowerthan25%in the control group. The two groups was not statistically significant(P>0.05), probalbly due to small sample size,if increasing the sample size willshow statistical differences. The forceps-style pleural biopsy trocar with bettersecurity and less pleural iatrogenic injury.7Compared with Cope needle,forceps-style pleural biopsy trocar equallysimple structure, low cost, suitable for primary hospitals and applications.