彩色血流应用于超声引导下经皮肾穿刺术中的临床意义

目的利用实时彩色血流观察超声引导肾穿刺活检,减少和减轻并发症的发生。方法应用彩色多普勒对肾穿刺术全过程进行实时监测,观察肾穿刺针道部位彩色血流变化,同时观察肾周有无异常回声。结果 64例穿刺取材成功率为100%,无1例严重并发症发生。14例术中无异常发现,术后轻微血尿。6例术中针道局部彩色血流异常,分别发生于,第一针后1例,第二针后3例,第三针后2例,超声表现为细束状红色血流直通肾周,前4例继续观察血流变化,确定是否终止操作,其中,2例1min内异常血流消失,肾被膜下无积液,改变角度后继续操作,2例发现肾周轻微积液,停止操作。发生肾周少量积液3例中,2例肾周可见窄带样低回声暗区,范围局限,最大厚度5～7mm,1例肾周低回声暗区最大厚度13mm,局限于右肾中下极。所有异常病例全部进行术后追踪观察,最少1次,最多3次,最长1例肾周局限性积液7天后完全消失,部分患者仅感腰背部轻度酸胀。结论实时彩色血流观察经皮肾穿刺术中穿刺部位血流的变化,是有效阻止和减轻肾周积液的最直观的检查手段。

Objective To stduy the real color folw in renal bilpsy and degree the comllications by ultrasond-guided.Methods Color Doppler flow imaging was used to watch the renal bilpsy at the real time,blood stream of needle road positon was observed closed,at the same time,whether it has abnormity echo around the kidney.Results All renal biopsy of 60 patients is succeedful,none had serious complications.14 patients were during the biopsy time period,but gross hematria later;6 patients local colour blood stream appear abnormal,1 case happened after the first biopsy;3 cases the second and 2 cases the third,The red thin color flow just out of the kidney from renal cortex to adipose capsule,the former 4 continue to wacth che change of flow,confirm whether end the opertion,2 cases abnormal color flow disappear within 1 minute,no perinephric hematoma happened,continue to operate when change the angle of biopsy;2 cases has light perinephric hematoma,then stop the opertion.among the 3 cases of perinephric hematoma,2 cases was founded narrow low echo around the kidney,the area was localization,the most thickness was 5-7mm,but 13mm appear in 1 case,the low echo located middle and lower part of right kidney.All the abnormal patients were make tracks for exam,one the less,three the most, for the serious case,the perinephric hematoma entirety disappear at the seventh day,most of cases only feel light turgidity in the back.Conclusion Real time color flow can truly display the blood of needle part in ultrasond-guided renal biopsy.it is most intuitionistic examine way to availably prevent or reduce perinephric hematoma.