超声引导下徒手法肾组织穿刺活检的应用价值  

Clinical application of ultrasound- guided manual percutaneous renal biopsy

作　　者：田树元[1] 蒋天安[2] 余永红[1] 胡岗[3] 

机构地区：[1]浙江省立同德医院超声科,杭州310012 [2]浙江大学附属第一医院超声科 [3]浙江省立同德医院肾内科,杭州310012

出　　处：《介入放射学杂志》2016年第5期408-411,共4页Journal of Interventional Radiology

摘　　要：目的比较超声引导下徒手肾穿刺活检术与使用穿刺架肾穿刺活检术的优缺点,探讨超声引导下徒手法肾组织穿刺活检的应用价值。方法使用18 G巴德一次性自动活检枪对甲组226例慢性肾病患者行超声引导下徒手肾组织穿刺活检术,乙组261例慢性肾病患者行超声引导下使用穿刺架肾穿刺活检术,按相同的穿刺活检标准决定穿刺部位、穿刺次数,取出的肾组织标本能完成完整的病理诊断,视作活检成功;术中记录穿刺次数,术后观察并发症。结果甲、乙两组患者平均每例的肾活检穿刺次数各为(2.97±0.43)次和(303±0.72)次、穿刺并发症发生率各为4.9%和2.7%、活检成功率各为98.2%和98.1%,两组间差异均无统计学意义;但两组患者穿刺失败的原因各有不同,使用穿刺架法穿刺失败主要是因为患者特别肥胖或肾脏位置特殊,徒手法穿刺失败主要与穿刺时穿刺枪的稳定性有关。结论超声引导下徒手法肾穿刺活检术与使用穿刺架法肾穿刺活检术均是安全有效的操作技术;徒手法更适合特别肥胖及某些肾脏位置特殊的患者,可作为使用穿刺架法重要的补充手段。Objective To compare the advantages and disadvantages of ultrasound-guided manual percutaneous renal biopsy （PRB） with those of puncture frame-assisted PRB, and to discuss the clinical application of ultrasound-guided manual PRB. Methods By using 18G bard disposable automatic biopsy gun, ultrasound-guided manual PRB was performed in 226 patients with chronic renal disease （group A） and puncture frame-assisted PRB was carried out in 261 patients with chronic renal disease （group B）. The puncture site and the puncture number were decided by the same puncture biopsy standard. Biopsy would be regarded as successful one if the removed kidney tissue sample was sufficient enough to accomplish a complete pathologic diagnosis. The number of puncturing and the postoperative complications were recorded. Results No statistically significant differences in the number of puncturing, the complication rate of puncturing and the biopsy success rate existed between the two groups. The reasons for the failure of puncturing in the two groups were different. The reasons of failure in group B were mainly due to the extraordinary obese of the patient or due to the abnormal location of kidney, while in group A the failure was mainly related to the stability of puncture gun during the performance of puncturing. Conclusion Both ultrasound-guided manual PRB and puncture frame-assisted PRB are safe and effective. Nevertheless, ultrasoundguided manual PRB is more suitable for the patients who are extraordinary obesity or whose kidney is abnormally located, and this technique can be used as an important supplementary means for ultrasoundguided puncture frame-assisted PRB.

关 键 词：肾活检 徒手 穿刺架 慢性肾病 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692[医药卫生—诊断学]