L9浅表探头腹部模式超声实时引导下不同穿刺部位经皮肾脏穿刺活检的诊断价值和安全性探讨

Diagnostic value and safety of percutaneous renal biopsy at different puncture sites guided by real-time abdominal mode ultrasound with an L9 superficial probe

目的:探讨超声实时引导下经皮肾穿刺活检的最佳操作模式,以安全有效的肾穿刺活检方法来提高穿刺成功率,避免严重并发症。方法:选取2019年11月至2022年3月吉安市中心人民医院诊治的肾脏疾病患者44例为研究对象,根据右肾穿刺位置分组,右肾下极为对照组(n=22),右肾中下极为观察组(n=22),两组均采取L9浅表探头腹部模式超声引导下于背部脊柱右侧旁由内向外经皮肾穿刺活检方法。比较两组一般资料,记录并分析比较两组穿刺针数、安全穿刺路径长度、活检组织条最长度和组织条内皮髓质占比、肾小球个数、肾周血肿并发症发生情况。结果:对照组和观察组44例患者均成功取材,成功率为100%,获取肾小球7~32个不等,均得出病理类型诊断。两组的年龄、体质量、病史等一般资料比较,差异均无统计学意义(均P>0.05)。两组穿刺的肾活检组织条最长度[(15.55±1.75)mm比(11.45±2.46)mm]和穿刺的肾活检组中的肾小球个数[(18.00±6.12)个比(11.32±2.38)个],差异均有统计学意义(t=6.20、4.66,均P<0.05)。两组穿刺后肾周血肿并发症轻症发生情况[100.0%(22/22)比27.2%(6/22)]差异有统计学意义(χ^(2)=3.86,P=0.001),两组均无严重并发症发生。两组在穿刺的安全穿刺路径长度、穿刺针数及穿刺组织条内皮髓质占比率的比较中,差异均无统计学意义(均P>0.05,)。结论:L9浅表探头腹部模式实时超声引导下由内向外经皮肾脏穿刺活检的方法具有良好的应用价值,穿刺成功率高,安全可靠,病理类型诊断满意。选取该操作模式下的经皮肾穿刺活检右肾中下极的方法来诊断肾脏疾病,病理诊断价值和穿刺安全性更高。

Objective To investigate the best operation mode for percutaneous renal biopsy guided by real-time abdominal mode ultrasound,to increase the puncture success rate,and avoid serious complications using safe and effective renal puncture biopsy.Methods A total of 44 patients with renal disease who received treatment in Ji'an Central People's Hospital from November 2019 to March 2022 were included in this study.According to the puncture location on the right kidney,these patients were divided into a control group(lower pole of the right kidney,n=22)and an observation group(middle and lower pole of the right kidney,n=22).A percutaneous renal biopsy was performed from the back to the right side of the spine under the guidance of abdominal mode ultrasound with an L9 superficial probe.General data,the number of punctures,the length of the safe puncture path,the maximum length of the tissue strip subjected to biopsy,the proportion of endothelial medulla in the tissue strip,the number of glomeruli,and the incidence of complications of perirenal hematoma were compared between the two groups.Results All 44 patients succeeded in sampling,with a 100%success rate.A total of 7-32 glomeruli were obtained.A pathological diagnosis was made in all 44 patients.There were no significant differences in age,body mass,or medical history between the two groups(all P>0.05).There were significant differences in the maximum length of renal tissue strip subjected to biopsy[(15.55±1.75)mm vs.(11.45±2.46)mm]and the number of glomeruli in renal tissue strip subjected to biopsy[(18.00±6.12)vs.(11.32±2.38)]between the two groups(t=6.20,4.66,both P<0.05).The difference in the incidence of complications of perirenal hematoma after percutaneous renal biopsy differed greatly between the two groups[100.0%(22/22)vs.27.2%(6/22),χ^(2)=3.86,P=0.001].No serious complications occurred in each group.There were no significant differences in the length of the safe puncture path,the number of punctures,or the proportion of endothelial medulla in tissue strips subjected to biopsy between the two groups(all P>0.05).Conclusion L9 superficial probe abdominal mode real-time ultrasound-guided percutaneous renal biopsy from the inside out has a good application value,a high puncture success rate,is safe and reliable,and yields a satisfactory pathological diagnosis.Percutaneous renal puncture biopsy of the middle and lower poles of the right kidney under the abdominal lobe has a higher pathological diagnostic value and is safer than percutaneous renal puncture biopsy of the lower pole of the right kidney.