平卧位经皮肾穿刺造瘘术结肠损伤几率的探讨——附432例报告

目的:探讨平卧位经皮肾穿刺造瘘术(percutaneous nephrostomy,PCN)并发结肠损伤的几率,为临床应用PCN提供参考.方法:对432例平卧位腹部CT扫描片进行分析,模拟自腰椎前切缘分别经过肾上极、肾门、肾下极的穿刺线,将结肠位置分为穿刺线前、线后或经过穿刺线,前者定义为无潜在损伤风险,后两者定义为有潜在损伤风险,从影像学分析平卧位PCN并发结肠损伤的几率.结果:平卧位经左侧肾上极、肾门、肾下极的穿刺中结肠有潜在损伤风险的几率分别为0、0、0.7%(3/432);经右侧肾上极、肾门、肾下极的穿刺中无1例有潜在损伤风险.结论:采用平卧位行PCN并发结肠损伤几率低,PCN术前常规做CT扫描检查,了解腹部内脏解剖位置关系可避免发生结肠损伤等严重并发症.

The risk of colon injury by percutaneous nephrostomy in supine position

Objective:To study the risk probability of colon injury by percutaneous nephrostomy(PCN) in supine position,and to provide reference for PCN.Methods:A series of 432 supine abdominal computed tomography(CT) scans were analyzed.A line of PCN from the anterior margin of the lumbar vertebra to the upper pole,or hilum,or lower pole of the kidney was simulated.From an anatomic point view,if the colon was located anterior to the line or on the line of the PCN,it represented a potential risk of colon injury.If the colon was located posterior to the line,it represented no potential risk of colon injury.The risk probability of colon injury by PCN in supine position was analyzed.Results:The potential risk of colon injury by PCN in supine position from the upper pole,or hilum,or lower pole of the left kidney was 0,0 and 0.7%(3/432) respectively,while the potential risk of colon injury was 0 when the right kidney was punctured.Conclusion:The potential risk of colon injury by PCN in supine position is extremely small.CT scan should be performed to identify the unusual anatomy before PCN to avoid happening of colon injury.