超声引导经皮肾穿刺活检方法的改进

摘要

目的 改进肾穿刺方法,以减少肾穿刺的并发症,提高标本质量.方法 将100例有肾穿刺适应症的患者随机分成3组,均在B超引导下用穿刺枪取材.A组:定位于右肾下极外侧,略偏近髓质,垂直进针;B组:定位于右肾下极外侧皮质为主的部位,垂直进针;C组:定位于右肾下极外侧,靠近肾外缘处,穿刺时针略向内倾斜,针尖对准肾皮质较厚的部位.结果 每厘米肾组织中肾小球个数C组最多,B组次之,A组最少.穿刺的成功率三组相似.血尿的发生率A组最高,B组次之,C组最小.结论 在应用活检枪的基础上,通过超声仪选择合适的穿刺位点及准确的导向对减少并发症,提高标本质量起决定性的作用.C组的穿刺方法每厘米肾小球个数最多,血尿发生率最低.%Objective To improve the method of percutaneous renal biopsy for decreasing the complications and ameliorating the sample quality.Methods One hundred patients who had an indication of performing the renal biopsy were divided into three groups and vertically punctured under ultrasound-guided by a biopsy gun to obtain a sample from the exterior side of the lower area of the right kidney,near the renal medulla(group A)and the area where the remal cortex was thicker(group B)and near the verge of the kidney,the needle was titled slightIy,aimed the tip Of the needle at the area where the renal eortex was thicker.(group C),respectively.Results The number of gIomeruIus of per centlmetre renal tissue was the most in group C,the medium in guoup B,and the least in group A.The rate of successful puncture was similar in the three groups.The incidence of hematuria occured ofter renal biopsy was the highest in group A,the medium in group B,and the lowest in group C.Conclusions Using a biOpsy gun,selecting a suitable puncture pomt and the accurate direction improving guided by ultrasound instrument are important in decreasing the complications after renal biopsy and improving the sample quality.Group C showed the most number of glomerulus and the lowesl rate of hematuria oceured after renal biopsy.