不同穿刺角度对超声引导下经皮肾活检取材质量和安全性的影响

目的 比较垂直进针和45°斜向下进针时经皮肾活检的取材质量和安全性.方法 回顾成都市核工业四一六医院肾内科2003年4月至2012年4月203例超声引导下经皮肾活检患者的临床资料,根据进针方向将患者分为2组：垂直进针组（A组）79例,45°斜向下进针组（B组）124例.比较分析2组患者取材质量（单次取材长度、切片包含肾小球数均值和取中皮髓交界处患者比例）和安全性（皮下血肿发生率、镜下血尿发生率、血红蛋白下降患者比例）.结果 两组单次取材长度的差异无统计学意义（0.89±0.09）cm比（1.08±0.05）cm,P＞0.05].B组切片中肾小球数（24±4）个比（15±6）个,P＜0.05]及取中皮髓交界处患者比例多于A组67.7％（84/124）比17.7％ （14/79）,P＜0.01].B组镜下血尿发生率23.4％ （29/124）比37.9％ （30/79）]和血红蛋白下降比例4.8％ （6/124）比15.2％ （12/79）]均低于A组（均P＜0.05）,两组皮下血肿的发生率差异无统计学意义（P＞0.05）.结论 45°斜向下进针不仅可提高肾活检的取材质量,还在一定程度上减少了其并发症的发生率.

Effect of different puncture angles on ultrasonic guided renal biopsy

Objective To comparison the quality and safety of percutaneous renal biopsy with vertical needle inserting and 45 degree of oblique needle inserting.Methods By reviewing 203 patients clinical reports from April 2003 to April 2012 in our department,we divide all cases into two groups,A for all cases with vertical needle inserting and B for 45 degree of oblique needle inserting.We analyzed the sampling quality （length for each sampling,the average number of glomerular in each tissue section and propotion of the patients who were taken sampling at the junction of cortical and medullary） and safety （the rate of ecchymoma,the rate of hematuria and the percentage of the patients with decreasing hemogloblin）.Results No statistically significant difference was found for the length of sampling （average for group A：（1.04 ± 0.09）cm,average for group B：（1.08 ± 0.05）cm）.More glomerular was found in group B and the difference was statistically significant（group A：15 ± 6,group B：24 ± 4; P ＜ 0.05）.The propotion of patients who were taken sampling at the junction of cortical and medullary in group B was more than that in group A（67.7％ （84/124） vs 17.7％ （14/79）,P ＜ 0.01）.Both of the rate of hematuria （23.4％ （29/124）vs37.9％ （30/79）,P ＜ 0.05） and the percentage of patients with decreasing hemogloblin of group B （4.8％（6/124） vs 15.2％（12/79）,P ＜ 0.05） were significantly lower than those of the group A.No significant difference was found for ecchymoma in two groups.Conclusions 45 degree of oblique needle inserting can lead to better sampling quality for percutaneous renal biopsy and decrease the rate of complication.