门诊常规开展肾活检的临床经验

Feasibility and safety of renal biopsy routine use in outpatient

目的:观察门诊常规开展肾活检的安全性、可行性。方法:在彩色多谱勒超声(机器型号GE-Logiq5)实时监测、引导下,采用负压吸引"斜角进针一秒钟穿刺法"在门诊为103例患者实施肾活检,其中男性66例,女性37例。平均年龄30.2岁(12～63岁)。早期入选病例均为肾病综合征(NS),其中激素治疗敏感、依赖34例,无效23例,余46例未予激素治疗。患者血肌酐正常、尿沉渣红细胞计数<50万/ml。结果:肾活检成功率为100%,术后仅1例(0.97%)出现短期自愈性肉眼血尿,肾周血肿发生率为34.9%,其中绝大部分为<2cm的微小血肿,无一例需输血,也无一例合并严重并发症导致肾切除或死亡。本组患者的肾活检病理种类均为原发性NS的常见类型。在23例激素治疗无效的患者中,其肾脏病理10例为局灶节段性肾小球硬化(FSGS)性肾炎,7例为膜性肾病(MN),两者占绝大多数(73.9%)。在46例未经激素治疗的初治NS患者中,也有47.8%患者为FSGS(8例)或MN(14例),而此种病理类型可能对激素不敏感或无效。结论:只要严格掌握适应证,术前、术中、术后严密的观察,采用合理的穿刺方法,可以保证门诊常规开展肾活检的安全,并能够及早明确肾脏病理改变,达到合理选择治疗方案,提高疗效、改善预后的目的。

Objective：To investigate the feasibility and safety of renal biopsy routine use in outpatient department. Methodology ： One hundred and three percutaneous renal biopsies （ male/female 66/37, aged from 12 to 63 ） were performed in the outpatient unit by renal biopsy device with negative pressure through an oblique angle, under direct visualization by ultrasound （ GE-Logiq5 ）. All of patients presented as nephrotic syndrome with normal renal function and microhematuria less than 5 × 10^4/ml. Of the 103 biopsies, 34 were prednisone sensitive but dependent, 23 were prednisone resistant, and the other 46 had never taken prednisone before. Results：The success rate of renal biopsy was 100%. Self- limited mild macrohematuria occurred in 0. 97% （1/103）. The frequency of hematoma was 34. 9% , most of which were minor hematoma with an extension less than 2 cm. There were no severe complications such as loss of blood requiting a blood transfusion, loss of kidney or death. All of pathological types were common type of nephrotic syndrome. Most of the 23 prednisone-resistant cases （73.9%） were focal segmental glomerulosclerosis （ 10/23 ） and membranous nephropathy （7/23）. However, there was also a large part （47.8%） of FSGS （8/46） and MN （14/46） in 46 cases without predui- sone application. Conclusion：Based on the strict indication restriction, intensive observation and proper biopsy method, the uhrasound-guided percutaneous renal biopsy in outpatient department is safe and feasible. This procedure is favorable for identifying the pathological changes at the early stage, guiding the proper treatment, and finally improving the prognosis.