多层螺旋CT评价经皮肾穿刺活检后出血及其临床相关因素分析  

The assessment of hemorrhage and clinical related after percutaneous renal biopsy with multislice spiral CT

作　　者：雷伟[1,2] 徐秀芳[3] 余日胜[1] 崔凤[2] 徐坤元[2] 

机构地区：[1]浙江大学医学院附属第二医院放射科,浙江杭州310003 [2]杭州市中医院放射科 [3]浙江医学高等专科学校

出　　处：《实用放射学杂志》2011年第10期1515-1519,共5页Journal of Practical Radiology

基　　金：基金项目：浙江省医药卫生科学研究基金（2010KYA008）.

摘　　要：目的探讨多层螺旋CT在经皮。肾脏穿刺活检后出血评价中的应用价值。方法90例患者经皮肾脏穿刺活检后行多层螺旋CT平扫．其中32例同时行增强扫描。结果48例（53．3％，48／90）患者发现血肿，根据CT表现将血肿分为3种类型：肾包膜下血肿39例（81．3％，39／48），合并轻度肾挫伤1例（2．6％，1／39）；吉氏筋膜下血肿6例（12．5％，6／48），合并轻度肾挫伤2例（33．3％，2／6）；腹腔血肿3例（6．3％，3／48），合并中度肾撕裂伤2例（66．7％，2／3）。3种类型血肿出血量大小分别为（9．47±10．13）ml、（214．60±125．74）ml、（1645．80±283．62）ml；经方差分析两两比较，3组相互之间均有显著性差异（P值均d0．01）。90例患者中IgA肾病51例（56．7％，51／90），发现血肿27例（52．9％，27／51）；非IgA肾病39例（43．3％，39／90），发现血肿21例（53．8％，21／39）；IgA肾病与非IgA肾病患者血肿发生率经统计学检验无统计学意义（X^2=0．007，P〉0．05）。无血肿组、血肿组的活化部分凝血酶原时间、血纤维蛋白原的差异有统计学意义（t=-2．259、-2．042，P值均＜0．05）。结论多层螺旋CT对评价经皮肾脏穿刺活检后出血有很重要临床意义，为临床治疗方案提供重要信息。Objective To evaluate the value of multislice helical CT in the assessment of hemorrhage after percutaneous renal biopsy. Methods Plain spiral CT scans were performed in 90 cases after percataneous renal biopsy, of whom 32 patients underwent additional enhanced CT scans. Results 48 cases（53.3%, 48/90）with extrinsic renal hematoma were detected by CT, based on CT manifestations, the renal hematomas could be divided into three types ： subcapsular hematomas in 39 cases （81.3%, 39/48 ）, accompanied with slight contusion of kidney in 1 case（ 2.6%, 1/39 ） ; perinephric capsule hematomas in 6 cases （ 12.5 %, 6/48 ） , accompanied with slight contusion in 2 cases（33.3%,2/6） ; peritoneal cavity hematomas in 3 cases（6.3% ,3/48） ,accompanied with medium laceration of kidney in 2 cases（66.7% ,2/3）. The volumes of hematomas were （9.47±10.13）ml for subcapsular hematoma of the kidney, （214.60 4±125.74）ml for perinephric capsule hematoma of the kidney and （1 645.80± 283.62）ml for peritoneal cavity hematoma, and there were significant differences among three types hematoma（P〈0.01 ）. There were 51 cases of IgA nephropathy accompanied with hematomas in 27 cases （ 52.9%, 27/51 ）, 39 cases of non-IgA nephropathy, accompanied with hematomas in 21 cases （53.8 %, 21/39）. The frequencies of hematoma in IgA nephropathy and non-IgA nephropathy were no of significant differences （X2 = 0. 007, P〉0.05 ）. The activated partial thromboplastin time and fibrinogen in non-hematoma group and hematoma group were of significant differences（t= -2. 259,-2. 042 ,P〈0.05 ）. Conclusion Multislice helical CT scan is of important value in the assessment of hemorrhage after percataneous renal biopsy,it can provide important informations for clinical treatment.

关 键 词：肾脏 穿刺 并发症 体层摄影术 X线计算机 

分 类 号：R692[医药卫生—泌尿科学] R814.42[医药卫生—外科学]