超声引导下经皮肾活检的安全性、成功率及并发症  

Analysis of Security,Achievement Ratio and Complications of Renal Biopsy under Type B Ultrasound in Children

作　　者：冯仕品[1] 徐鸣[1] 李莎[1] 金梅[1] 杨胜[1] 罗苇[1] 汤锋[2] 刘莉[1] 刘光泽[1] 史宏[1] 

机构地区：[1]成都市儿童医院肾内科,成都610017 [2]中国人民解放军第452医院肾病中心,成都610021

出　　处：《实用儿科临床杂志》2007年第5期365-366,共2页Journal of Applied Clinical Pediatrics

摘　　要：目的评价、分析儿童肾活检的安全性、成功率及并发症。方法肾脏病患儿100例在B超引导下经皮穿刺活检,用20g/L利多卡因逐层局部麻醉至肾包膜,不能配合者应用氯硝西泮,镇静后进行。B超定位后,用皮钻或手术刀片于穿刺点皮肤切开0·3～0·5cm切口,在B超监视下将穿刺针逐层进针到达肾脏被膜时,在平静呼吸时嘱患儿屏住呼吸(肾脏位置较高的患儿需深吸气后屏住呼吸),开枪切割,快速拔出穿刺针。术者用手掌压迫穿刺部位10～15min,腹带、沙袋加压包扎。结果99例获得足够肾组织,平均肾小球7～52个[(23.1±12.1)个],满足了光镜、电镜、免疫荧光三镜的需要,并作出完整的病理诊断,1例虽穿刺成功,但全为髓质组织,无肾小球,总成功率99%。其主要并发症:均有疼痛,一过性肉眼血尿3/100例,腰部不适15/100例。无肾周血肿、感染、休克等严重并发症发生。结论超声引导下经皮儿童肾活检安全可靠,成功率高,并发症少,其病理诊断对临床治疗及预后评价具有明确的指导意义。Objective To evaluate and analyze the security, achievement ratio and complications of renal biopsy in children. Methods After local anaesthesia layer of layer to the kidney membrane with 20 g/L lidocaine, 100 children with kidney diseases were punctured through skin under the guidance of type B ultrasound, who cannot coordinate were calmed with clonazepam, A 0, 3 to 0, 5cm cut was made at the point of puncture with a skin drill or a surgical knife being orientated by B ultrasound, The puncture needle was inserted layer of layer to the kidney membrane under the surveillance of B ultrasound, In the smooth breathing condition, children were asked to stop breath, If the location of the kidney was high,the children was asked to take a deep inspiration before stopping breath, at the same time,the tissues were shot and cut, and then the needles were withdrawn rapidly, Then the puncture point was pressed with palms for 10 to 15 minutes,and the operator enswathed compressively with a belly belt and a sandbag, Results The amount of kidney tissues from 99 children, with an average of 7 - 52 （23. 1± 12. 1 ） glomerulus was enough to meet the need of light, electron and immunofluorescenee microscopy, and the complete pathological diagnosis were done, After successful puncturing, renal medulla tissues were obtained, but without renal glomerulus in only one case, The total success ratio was 99%, Main complications were pain more or less in all children,temporal naked eye hematuria in 3 eases（3% ） , and loin discomfortable（ 15% ）, Serious complications such as perirenal hematoma, infection, shock did not occur. Conclusions It is sate to do renal biopsy in children with the orientation of type B ultrasound, There is a significance for the pathological diagnosis and clinical therapy and estimation of the prognosis.

关 键 词：超声检查 肾 活组织检查 儿童 

分 类 号：R726.91[医药卫生—儿科]