142例超声引导下经皮肾穿刺活检成功率的对比分析

目的本文通过对比分析两组医生分别采用两种不同入路途径进行超声引导下肾穿刺活检取样成功率,实现不同入路途径的优缺点比较,为初学者提供操作指导。方法本文研究分为两部分：第一部分,对不同入路途径下超声引导下肾穿刺活检取样成功率进行对比分析,具体方法为：对2012年7月至2013年6月在我科进行超声引导下肾穿刺活检术的142名患者根据进针途径的不同分成两组,其中A组患者69人,采用头端进针；B组患者73人,采用尾端进针；两组患者的年龄基本匹配。第二部分,对不同医生操作下超声引导下肾穿刺活检取样成功率进行对比分析,具体方法为：对我科具备操作资质的医师进行分组,其中Ⅰ组为操作次数超过100例的医生,Ⅱ组为操作次数不超过20例的医生。患者就诊时,两组医生间隔操作,进针途径随机抽取。超声引导下使用自动活检枪,18G组织切割针行右肾下极穿刺活检,记录穿刺进针次数,有效样本数。结果所有病例均获得足够的标本；Ⅰ组医师两组不同入路的操作次数、成功率差异无统计学意义（P〉0.05）；Ⅱ组的医师A组的操作次数明显高于B组,成功率明显低于B组,差异有统计学意义（P〈0.01）；A组里Ⅰ组医师的成功率明显高于Ⅱ医师,操作次数低于Ⅱ医师,差异有统计学意义（P〈0.01）；B组里Ⅰ组医师与Ⅱ医师的操作次数、成功率差异无统计学意义（P〉0.05）。结论自头端进针途径较尾端进针途径具有进针次数少等各种优点,但该操作对操作者的要求较高,需要初学者勤加练习。由于肾穿刺活检的并发症的发生率与穿刺次数相关,所以,初学者如自头端进针途径取材两次均不满意,需及时更换操作者或更换穿刺入路采取自尾端进针,以避免过度损伤肾脏及并发症的产生。

Comparison of different ways into renal biopsy under ultrasound guidance for 142 cases

Objective In the context, the success rate is analyzed through the comparison of the doctors who use two different ways into the road of renal biopsy under ultrasound guidance for sampling. Methods According to the different ways into the needle, 142 patients who get the operation of renal biopsy under ultrasound guidance in our department during July 2012 to June 2013 are divided into two groups. The first group which is defined as group A includes 69 patients and a needle is put into from the head end. The second group which is defined as group B includes 73 patients and a needle is put into from the end. Doctors of our department are also separated into two groups and the doctors＇operating frequency is more than 100 in I group. However, the doctors＇operating frequency is less than 20 cases in H group. Results All cases received enough specimens. There is no statistically significant for I group because P 〉 0. 05, but there is statistically significant for 11 group because P 〈 0. 01. Conclusions There are many advantages when the needle is inserted from the head, but the operation demand is higher than the needle from the end of needle. Due to the complications of renal biopsy is associated with the number of punctures, so the operator should be replaced or change the operation way when the beginners can not get satisfied results.