经皮超声引导下肾脏穿刺活检的技巧经验分享

Experience sharing of percutaneous ultrasound guided renal biopsy

目的 总结经皮超声引导下肾脏穿刺活检的技巧,以提高活检取样成功率、降低并发症发生率。方法 抽取74例需进行肾脏穿刺活检的患者,局部麻醉(局麻)后进行经皮超声引导下实时活检穿刺。总结活检时穿刺的技巧,分析穿刺成功率、并发症发生率及病理诊断结果。结果 74例患者共获得103份组织条,穿刺成功率为98.6%(73/74)。74例患者中5例出现肾周少量血肿,其中2例为24 h后复查超声出现肾周少量血肿, 3例为术后1周运动时出现腰部不适,复查显示肾周少量血肿;肾周血肿2周后自行吸收消失,无其他并发症出现。74例肾组织穿刺病理结果显示,免疫球蛋白A(IgA)肾病11例,膜性肾病19例,新月体性肾小球肾炎4例,局灶节段硬化性肾小球肾炎7例,肾小球微小病变5例,间质性肾炎3例,狼疮性肾炎5例,系膜增生性肾小球肾炎6例,过敏性紫癜肾炎2例,糖尿病肾病9例,淀粉样变性肾病3例。结论 经皮超声引导下肾脏穿刺活检是一种成功率高且并发症较少的方法 ,而掌握精准医疗理论后超声科和肾内科医师与患者配合是穿刺成功及减少并发症发生的关键。

Objective To summarize the puncture skills in percutaneous ultrasound guided renal biopsy,so as to improve the success rate of biopsy sampling and reduce the incidence of complications.Methods A total of 74 patients requiring renal biopsy were selected,and percutaneous ultrasound guided real-time biopsy was performed after local anesthesia.The puncture skills during biopsy were summarized,and the success rate of biopsy,the incidence of complications and the results of pathological diagnosis were analyzed.Results 103 tissue strips were obtained in 74 patients,and the success rate of biopsy was 98.6%(73/74).Among the 74 patients,5 cases had a small amount of perirenal hematoma,of which 2 cases had a small amount of perirenal hematoma by ultrasonography 24 h later,and 3 cases had a small amount of perirenal hematoma due to lumbar discomfort during exercise1 week after surgery.The above conditions were absorbed and disappeared 2 weeks later without any other complications.The pathological results of 74 cases of renal biopsy showed that there were 11 cases of immunoglobulin A(IgA)nephropathy,19 cases of membranous nephropathy,4 cases of crescentic glomerulonephritis,7 cases of focal segmental sclerosing glomerulonephritis,5 cases of minimal change glomerulopathy,3 cases of interstitial glomerulonephritis,5 cases of lupus nephritis,6 cases of mesangial proliferative glomerulonephritis,2 cases of allergic purpura nephritis,9 cases of diabetes nephropathy,and 3 cases of amyloid nephropathy.Conclusion Percutaneous ultrasound guided renal biopsy is a method with high success rate and few complications.After mastering the theory of precision medical treatment,the cooperation between ultrasound department and nephrologists and patients is the key to successful puncture and reduce complications.