经皮肾取石术肾穿刺通道大小对肾血管损伤影响的超声影像学研究

Study on effect of size of renal biopsy tunnel on renal vessels injury estimated by ultrasound image in percutaneous nephrolithotomy

目的探讨经皮肾取石术肾穿刺通道大小对肾血管损伤的超声影像学的改变。方法对2008年3月～2011年8月期间符合入选条件的310例患者,按16～24 F通道,随机分为5组,由同一手术医师行经皮肾碎石取石术,术中同时使用超声增强造影(CEUS),记录增强开始时间和峰值强度(PI),并同时记录出血量、手术时间、结石取尽率等。结果 310例患者均成功建立经皮肾工作通道,无需中转开放手术。24F与16F相比,取石速度明显快于16F的通道,但出血量也多于16F,CEUS的PI值明显大于16F(P<0.05),差异有统计学意义。各组结石取尽率差别不大。结论 CEUS能准确显示肾脏活动性出血的部位和出血的严重程度,可用于术中经皮肾手术通道的选择和出血的判断,有广阔的应用前景。在经皮肾通道的选择中,24F是一个临界值。

Objective To explore the ultrasound image change of renal vessel with the size of percuta- neous renal biopsy tunnel in percutaneous nephrolithotomy （PNL）. Methods From March 2008 to August 2011,310 cases were rendered with percutaneous nephrolithotomy and classified 5 teams by tunnel size of 16F to 24F. All the pereutaneous nephrolithotomy were performed by the same surgeon, and recorded time of intensification start and peak intensity （PI） with contrast-enhanced ultrasonography （CEUS） meantime. The amount of bleeding,operation time and the rate of residual calculus were recorded and analyzed. Results 310 cases were successfully rendered for PNL with contrast-enhanced ultrasonography, with no resort to open operation. Compared with 16F group,24F group had less time of operation,but at the cost of more bleeding volume,with apparent bigger PI value under CEUS, and all the differences were of statistical significance （all P 〈 O. 05） between the two groups. There was no statistical significance in the rate of residual calculus between the two groups. Conclusions CEUS can accurately demonstrate the location and degree of active hemorrhage in percutaneous nephrolithotomy, indicating its broad application in the future. 24F tract may be a critical value in nephrolithotomy tract.