经皮肾穿刺取石术中彩色多普勒超声引导的作用

Clinical Application of Color Doppler Ultrasound in the Guidance of Percutaneous Nephrolithotomy

目的:探讨在经皮肾取石术(PCNL)中利用彩色多普勒超声引导穿刺避免肾血管损伤的临床价值。方法:分析2006年8月至2007年10月66例彩色多普勒超声引导的PCNL术,所有患者均进行普通B型超声波与彩色多普勒超声探查并进行自身对照,先用普通B型超声波设计入路,再在同一切面上使用彩色多普勒超声检查,若入路上有明显肾血管经过则重新调整入路,在彩色多普勒超声实时引导下穿刺进针。结果:66例患者彩色多普勒超声引导PCNL术均获成功。其中12例通过彩色多普勒超声检查发现原超声波设定入路上的肾血管并重新设定穿刺路径,有效避免直接损伤肾血管,占总例数的18.2%(12/66)。所有患者术中术后均无大出血和动静脉瘘等严重并发症的发生。结论:彩色多普勒超声引导PCNL术中穿刺,能确切避开肾血管,提高手术安全性和准确性,有效减少PCNL手术并发症。

Objective： To explore the clinical effect of color Doppler ultrasound in the guidance of percutaneous nephrolithotomy（PCNL） to avoid injuring renal vessels.Methods： From Aug,2006 to Oct,2007,a total of 66 cases of PCNL under color Doppler ultrasound guidance were performed in our hospital.All patients were checked and the primary route of puncture was designed with B mode ultrasound.Then,color Doppler ultrasound was used in the same section to detect whether there were any renal vessels passing through the route.And the route of puncture was modified according to the results of color Doppler ultrasound.Results： Vessels in the puncture routes were found by color Doppler in 18.2%（12/66） cases and were modified later,efficiently avoid injuring the renal vessels directly.All punctures were successful and all the patients had no serious complications such as arterio-venous fistul and haemorrhage.Conclusion： Color Doppler ultrasound can detect clearly the renal blood vessels passing through the route.Guidance under color Doppler ultrasound could improve the safety and efficiency in PCNL,especially in those renals which vessels are abnormal.