儿童超声引导下经皮肾活检术的有效性和安全性分析  

Efficacy and safety of ultrasound-guided percutaneous renal biopsy in children

作　　者：王伟镇[1] 李颖嘉[1] 苏春 刘志 赖楠 劳明珍 乔宜格 王雪琴 高慧欣 马焕容 WANG Wei-zhen;LI Ying-jia;SU Chun;LIU Zhi;LAI Nan;LAO Ming-zhen;QIAO Yi-ge;WANG Xue-qin;GAO Hui-xin;MA Huan-rong(Department of Medicine Ultrasonics,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院超声医学科,广东广州510515

出　　处：《中国临床医学影像杂志》2022年第12期869-873,共5页Journal of China Clinic Medical Imaging

基　　金：国家自然科学基金资助项目(81801720);南方医科大学南方医院院长基金资助项目(2021A005)。

摘　　要：目的:分析儿童超声引导下皮质切线入路经皮右肾活检术的取材充分性及安全性。方法:回顾性收集205例儿童肾病病例,均行超声引导下皮质切线入路经皮右肾活检术(以右肾约中下极交界处为穿刺点,穿刺入路方向为从外上向内下斜切)。统计取材充分性及并发症情况,并用二元Logistic回归分析探讨相关影响因素。结果:样本肾小球个数为4~83,平均(25±12),其中190例(92.7%)评价为“充分”,15例(7.3%)为“次充分”,0例(0%)为“不充分”,取材较充分与肾皮质厚度较厚有关(OR=0.092,95%CI=0.010~0.828,P=0.033)。术后13例(6.3%)发生肾周血肿,与术前血小板含量较低(OR=0.984,95%CI=0.973~0.995,P=0.004)及肾皮质厚度较薄(OR=0.001,95%CI=0.000~0.266,P=0.015)有关。剔除术前肉眼血尿患者后余177例进行分析,术后22例(12.4%)发生肉眼血尿,与患儿体质量指数(BMI)值较高(OR=1.178,95%CI=1.006~1.381,P=0.042)及术前血小板含量较低(OR=0.992,95%CI=0.986~0.998,P=0.011)有关。结论:儿童超声引导下皮质切线入路经皮右肾活检术取材成功率高,并发症发生率低。Objective:To analyze the adequacy and safety of ultrasound-guided percutaneous biopsy of the right kidney via cortical tangential approach in children.Methods:A total of 205 cases of nephrosis in children were retrospectively collected,and all of them underwent ultrasound-guided percutaneous biopsy of the right kidney via cortical tangential approach(the puncture point was selected at about the junction of the middle and lower pole of the right kidney,and the direction of puncture approach was oblique cutting from the outside up to the inside down).The adequacy of biopsy samples and complications were assessed,and the related factors were analyzed by logistic regression.Results:The number of glomeruli in the samples ranged from 4 to 83,with an average of(25±12),of which 190(92.7%)were evaluated as“sufficient”,15(7.3%)as“sub-sufficient”,and 0(0%)as“insufficient”.The fuller samples were related to the thicker renal cortex(OR=0.092,95%CI=0.010~0.828,P=0.033).Perirenal hematoma occurred in 13 cases(6.3%)after biopsy,which was related to low preoperative platelet content(OR=0.984,95%CI=0.973~0.995,P=0.004)and thinner renal cortex(OR=0.001,95%CI=0.000~0.266,P=0.015).Analyzing the remaining 177 cases after excluding with patients with preoperative gross hematuria,22 cases(12.4%)developed gross hematuria after operation,which was related to higher body mass index(BMI)(OR=1.178,95%CI=1.006~1.381,P=0.042)and lower preoperative platelet content(OR=0.992,95%CI=0.986~0.998,P=0.011).Conclusion:The ultrasound-guided percutaneous biopsy of the right kidney via cortical tangential approach is feasible in children with a high success rate and a low incidence of complications.

关 键 词：肾疾病 儿童 活组织检查 针吸 超声检查 介入性 

分 类 号：R692[医药卫生—泌尿科学] R445.1[医药卫生—外科学]