彩色多普勒超声引导经皮肾穿刺避免损伤肾血管的临床应用价值

Clinical analysis of Color Doppler ultrasound in the guidance of percutaneous Nephrolithotomy (PCNL)to avoid injuring the renal vessels

目的探讨彩色多普勒超声在经皮肾取石术(percutaneous nephrolithotomy,PCNL)穿刺引导中避免肾血管损伤的临床应用价值。方法分析2006年2月至2006年8月110例彩色多普勒超声引导的PCNL术,所有患者均进行黑白超声波与彩色多普勒超声探查并进行自身对照,先用黑白超声波设计入路,再在同一切面上使用彩色多普勒超声,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 110例患者彩色多普勒超声引导PCNL术均获成功。其中15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13.6%(15/110)(确切概率法P=0.035)。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,提高手术安全性和精确性,有效减少PCNL手术并发症。

Objective To explore the clinical value of Color Doppler ultrasound in the guidance of percutaneous nephrolithotomy （PCNL）to avoid injuring the renal vessels. Methods From Feb 2006 to Aut 2006, a total of 110 cases of PCNL under Color Doppler ultrasound guidance in our hospital. All patients were checked by B mode ultrasound and the primary route of puncture was designed. Color Doppler was used in the same section to detect whether there were any renal blood vessels passing through the route. If there were any renal blood vessels, the route must be modified until it punctured away from any obvious blood vessels. Results Vessels passing through puncture routes were found by color Doppler in 15 cases and were modified later, efficiently avoiding injuring the renal vessels directly, accurring in 13.6% of the whole cases （P=0.035）. All punctures were successful and all the patients had no serious complications such as arterio-venous fistul and haemorrhage. Conclusions Color Doppler ultrasound can detect the renal blood vessels passing through the route and show clearly. Guidance of Color Doppler ultrasound could improve the satety and efficiency in PCNL, especially in those renals which vessels are abnormal.