B超联合实时彩色多普勒超声在降低经皮肾镜取石术出血并发症中的意义

The clinical efficacy in decreasing hemorrhagic complication by B-ultrasound combined with color Doppler ultrasound guidance in percutaneous nephrolithotomy

目的：探讨B超联合彩色多普勒超声引导穿刺对降低经皮肾镜取石术（PCNL）出血并发症的意义。方法回顾性分析323例肾结石和／或输尿管结石行PCNL患者的临床资料，男186例，女137例。年龄27-82岁，平均54岁。根据穿刺引导方式，分为单纯B超灰阶扫描引导穿刺组（ B超组，147例）及B超联合彩色多普勒超声引导穿刺组（彩超组，176例），比较两组的临床资料及手术并发症，尤其是出血并发症的发生情况。结果彩超组和B超组患者的年龄[（53．2±12．9）岁vs．（54．7±9．1）岁]、身高[（165．1±8．5） cm vs．（164．6±6．9） cm]、体重[（66．1±19．2） kg vs．（64．9±16．3） kg]、结石负荷[（680．5±56．4） mm2 vs．（654．0±76．9） mm2]、手术时间[（117．6±55．1） min vs．（121．4±54．3） min]、结石取净率（90．7％vs．91．3％）及术后住院时间[（4．9±2．2） d vs．（4．7±1．7）d]比较，差异均无统计学意义（P＞0．05）。彩超组术后因出血需要输血的比例（1．1％）和需要肾动脉栓塞的比例（0）均低于B超组（分别为3．4％和3．4％），两组差异具有统计学意义（P＜0．05）。彩超组术后发生肾动静脉瘘（0）、假性动脉瘤（0）和肾周血肿（0）的比例均低于B超组（分别为2．0％、2．0％、1．4％），差异具有统计学意义（P＜0．05）。结论 B超联合彩色多普勒超声引导穿刺可以实时监视并避开肾脏的较大血管，可有效降低PCNL出血并发症的发生。

Objective To evaluate the clinical significance of using B-ultrasound combined with color Doppler ultrasonography guidance in percutaneous nephrolithotomy （ PCNL） to decease the incidence of hemorrhagic complication.Methods A total of 323 patients with renal or urethral stones who had undergone PCNL were retrospectively categorized into 2 groups.Group 1 （147 patients） underwent PCNL with single B-ultrasound guidance while group 2 （176 patients） underwent PCNL with combined B-ultrasound and color Doppler ultrasound guidance. The clinical characteristics and complications, especially hemorrhagic complications in the two groups were recorded and compared.Results There were no statistical significances in age [ （ 53.2 ±12.9 ） years vs.（ 54.7 ±9.1 ） years ] , hight [ （ 165.1 ±8.5 ） cm vs.（ 164.6 ± 6.9） cm], weight[ （66.1 ±19.2） kg vs.（64.9 ±16.3） kg], stone burden [（680.5 ±56.4） mm2 vs. （654.0 ±76.9） mm^2], operative time[（117.6 ±55.1） min vs.（121.4 ±54.3） min], stone-free rate （90.7%vs.91.3%）, or postoperative hospital stay [（4.9 ±2.2）d vs.（ 4.7 ±1.7 ）d] between the two groups.In the B-ultrasound combined color Doppler ultrasound guidance group, the rate of blood transfusion （1.1%vs.3.4%） and super-selective embolization （0 vs.3.4%） was significantly lower than that of the single B-ultrasound guidance group.Besides, the incidents of renal arteriovenous fistula （0 vs.2.0%）, pseudoaneurysm （0 vs.2.0%）, and perirenal hematoma （0 vs.1.4%） were significantly lower in the B-ultrasound combined color Doppler ultrasound guidance group than that of the single B-ultrasound guidance group.Conclusion Using B-ultrasound combined color Doppler ultrasound guidance during PCNL resulted in the real-time detection and avoidance of the renal blood vessels during puncture and decreased the incidence of hemorrhagic complications.