超声引导肾锥体精准穿刺钝性分离法在无积水肾盂造瘘术中的临床应用:一种无积水肾盂造瘘新方法  

Ultrasound-guided precise puncture and blunt separation of the renal cone under contrast-enhanced ultrasound guidance for hydronephrosis free pyelostomy:a new method for hydronephrosis free pyelostomy

作　　者：李寿鹏 麦海星[2] 田霁松 沈东来[2] 王威[2] 陈海瑞 张旭[2] 李秋洋[1] 罗渝昆[1] Li Shoupeng;Mai Hairing;Tian Jisong;Shen Donglai;Wang Wei;Chen Hairui;Zhang Xu;Li Qiuyan;Lluo Yukun(Department of Ultrasound Diagnosis,the First Medical Center of PLA General Hospital,Beijing 100853,China;Department of Urology,the Third Medical Center of PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第一医学中心超声诊断科,北京100853 [2]解放军总医院第三医学中心泌尿外科医学部,北京100039

出　　处：《微创泌尿外科杂志》2024年第4期252-256,共5页Journal of Minimally Invasive Urology

基　　金：军队后勤保障部科研专项课题(21BJZ13);国家自然科学基金面上项目(82371985)。

摘　　要：目的:探讨超声造影辅助下超声引导肾锥体精准穿刺钝性分离法在无积水肾盂造瘘术中的临床应用情况。方法:回顾性分析2022年5月至2024年4月在解放军总医院第一医学中心进行超声引导下无积水肾盂造瘘的患者11例,其中单侧肾盂造瘘6例,双侧肾盂造瘘5例,共16例次无积水肾盂穿刺造瘘术。均在超声引导下徒手穿刺目标肾锥体并采用钝性分离法置入导丝。统计穿刺过程中的首次穿刺成功率、平均穿刺针数、穿刺时间、总置管时间、并发症情况。结果:所有患者均穿刺成功,首针穿刺成功率为81.25%,平均穿刺针数为1.19±0.4、平均穿刺时间为(122.19±22.55)s、平均置管时间为(674.19±46.61)s;所有肾盂穿刺造瘘均未出现活动性出血及其他严重并发症,2例次术后第2天引流不畅重新调整引流管。结论:超声造影辅助下超声引导肾锥体精准穿刺钝性分离法在无积水肾盂造瘘术中应用效果良好,具有较高的安全性和可行性,为泌尿系损伤无法行输尿管支架的患者提供了安全有效的治疗方法,值得推广。Objective:To explore the clinical application of blunt dissection through precise puncture of the renal pyramid using contrast-enhanced ultrasound-assisted ultrasound gudiance in nephrostomy for non-hydronephrotic renal pelvis.Methods:A retrospective analysis was conducted on 11 patients who underwent ultrasound-guided hydronephrostomy in the First Medical Center of the PLA General Hospital from May 2022 to April 2024.Among them,6patients underwent unilateral pyelostomy and 5 patients underwent bilateral pyelostomy.A total of 16 sides underwent hydronephrocentesis and hydronephrostomy.All 16 sides had no hydronephrosis in the renal pelvis.The success rate of the first puncture,average number of puncture needles,puncture time,total catheterization time,and complications during the puncture process were recorded.Results:All patients were successfully punctured,with a first puncture success rate of 81.25%,an average number of puncture needles of 1.19±0.4,an average puncture time of(122.19±22.55)s,and an average catheterization time of(674.19±46.61)s;All renal pelvis puncture fistulas did not show active bleeding or other serious complications,with two cases having poor drainage and re-adjust the drainage on the second day after surgery.Conclusion:The ultrasound-guided precise puncture and blunt separation method of the renal cone with the assistance of contrast-enhanced ultrasound has a good application effect in hydronephrostomy,with high safety and feasibility.It provides a safe and effective treatment method for patients with urinary tract injury who are unsuitable for ureteral stenting,and is worth promoting.

关 键 词：无积水肾盂造瘘 肾锥体精准穿刺 钝性分离 超声造影 超声引导下经皮肾盂穿刺造瘘术 

分 类 号：R692.7[医药卫生—泌尿科学]