两种穿刺法行肾脏组织活检患者肾功能和获取肾小球数、肾周血肿发生率的比较  

Comparison of efficacy and safety between negative pressure suction puncture and biopsy-gun puncture in ultrasound-guided percutaneous renal needle biopsy

作　　者：余海峰[1] 施慧飞 谢海萍[1] 周剑宇[1] 冯成[1] 聂艳芳[1] 傅秋月[1] 李春胜[1] 张薇[1] 

机构地区：[1]浙江省台州市中心医院肾内科,318000

出　　处：《中华全科医师杂志》2015年第9期670-674,共5页Chinese Journal of General Practitioners

摘　　要：目的 探讨不同的经皮肾穿刺活检方法对穿刺肾功能的影响,获取的肾小球数量及肾周血肿发生率的差异.方法 浙江省台州市中心医院2009年6月至2014年12月资料完整的肾穿刺患者共453例,2012年4月前采用B超定位后徒手盲法负压抽吸穿刺法,221例;2012年5月后采用B超直视下穿刺枪穿刺法,232例.肾穿刺前及后(6~16 d)应用发射单光子计算机断层扫描仪(ECT) 99mTc二乙稀三胺五乙酸测定双肾肾小球滤过率(GFR),比较穿刺前后GFR水平的变化.肾穿后1 ~10d行肾脏B超检查.比较两种穿刺方法获取的肾小球数量、肾周血肿发生率差异.结果 ①负压抽吸法肾穿前GFR(37.7±11.6) ml/min,穿刺后(38.3±11.7) ml/min(t =0.485,P=0.628);直视穿刺枪法肾穿前GFR(36.8±11.3) ml/min,穿刺后(37.4±11.9) ml/min(t=0.565,P=0.572).②肾穿刺后肾周血肿直径>5 cm的发生率5.3% (24/453),肾周血肿直径≤5 cm的发生率6.0%(27/453).血肿>5 cm者穿刺前GFR为(37.5±10.7) ml/min,穿刺后GFR为(33.5±10.1)ml/min,差异有统计学意义(t=2.103,P=0.038).③负压抽吸法获取肾小球数(26.4±15.9)个,直视穿刺枪法获取肾小球数(20.6±9.9)个,差异有统计学意义(t =4.648,P=0.000).④负压抽吸法肾周血肿发生率6.8%(15/221),直视穿刺枪法15.5% (36/232),差异有统计学意义(x2=8.634,P=0.003).⑤直视穿刺枪法肾穿成功率显著高于负压抽吸法(98.7±7.5)%与(61.4±25.8)%,=5.453,P=0.000.结论 肾穿刺后出现大血肿者短期内穿刺肾GFR水平下降.负压抽吸法肾活检获取肾小球数较多,肾周血肿发生率及穿刺成功率较低.Objective To compare the efficacy and safety of different percutaneous renal needle biopsy methods.Methods Total 453 patients underwent renal needle biopsy in Taizhou Central Hospital during June 2009 and December 2014,including 221 patients received ultrasound-guided negative pressure suction puncture and 232 patients received ultrasound-guided biopsy gun puncture.The glomerular filtration rates (GFRs) were measured with single photon computed tomography [ECT (99m Tc-DTPA)] before and after renal puncture.The amount of glomeruli obtained and incidence of perirenal hematoma were documented and compared between two groups.Results GFRs of punctured renal in negative pressure group were (37.7 ± 11.6) ml/min before puncture and (38.3 ± 11.7) ml/min after puncture (t =0.485,P =0.628) ; those in biopsy gun group were (36.8 ± 11.3) ml/min before puncture and (37.4 ± 11.9) ml/min after puncture (t =0.565,P =0.572).The incidence of perirenal hematoma > 5 cm and ≤5 cm was 5.3 % (24/453) and 6.0% (27/453),respectively.In hematoma > 5cm group the GFR was decreased from (37.5 ± 10.7) ml/min before renal puncture to (33.5 ± 10.1) ml/min after puncture (t =2.103,P =0.038).The amount of glomeruli obtained by negative pressure puncture and by biopsy gun puncture was 26.4 ± 15.9 and 20.6 ± 9.9,respectively (t =4.648,P =0.000).The incidence of perirenal hematoma in negative pressure and biopsy gun groups was 6.8% (15/221) and 15.5% (36/232),respectively (x2 =8.634,P =0.003).The successful rate of renal needle biopsy in biopsy gun group was significant higher than that in negative pressure group [98.7 ± 7.5 % vs.61.4 ± 25.8%,t =5.453,P =0.000].Conclusions The large hematoma in punctured kidney would reduce the GFR in short-time.Negative pressure suction puncture may obtain more glomeruli and have lower incidence of perirenal hematoma,but have lower successful rate of renal needle biopsy.

关 键 词：活组织检查 针吸 肾 肾小球滤过率 血肿 

分 类 号：R692[医药卫生—泌尿科学]