彩超实时引导肾活检156例临床体会

肾脏病理活检对肾脏疾病具有明确诊断、指导治疗及判断预后等意义,在肾脏病学的发展中发挥了重要作用[1]。经皮肾活检应用于临床有近50年的历史,是目前最普及的肾活检方法。但如何提高肾活检成功率,减少并发症是临床肾脏病学者关注的问题。我院自2000年开展彩超实时引导肾活检156例,现报告如下。1材料与方法2000年5月~2004年10月间,我们先后对156例病人实施经皮肾活检术,均在彩超实时引导下进行。本组其中男106例,女50例,年龄13~67岁,平均年龄39岁。包括慢性肾炎127例,狼疮性肾炎12例,紫癜性肾炎12例,糖尿病肾病5例,所有病例术前均常规检查…     

高频彩超引导经皮穿刺活检用于骨肿瘤诊断

目的：探讨高频（１０ ＭＨｚ） 彩超引导经皮穿刺活检诊断骨肿瘤的价值。材料和方法：应用自动活检装置和粗针手动活检在高频彩超引导下对６０ 例骨肿瘤穿刺活检。结果：彩超引导自动活检３０ 例,取材成功率９６．７ ％ （２９／３０） ;彩超引导手动活检３０ 例,取材成功率９０．３ ％ （２８／３０） 。恶性骨肿瘤取材率９７．８ ％ （４４／４５） ;良性骨肿瘤取材率８６．７ ％ （１３／１５） 。结论：高频彩超引导经皮穿刺活检不仅方便经济,痛苦小,不受放射线照射,取材成功率高,而且高频探头使自动活检装置在溶骨型骨肿瘤的应用成为可能。     

彩超引导下自动活检枪在乳腺包块穿刺活检中的应用

目的：探讨彩超引导下利用自动活检枪对48例乳腺包块穿刺活检。方法：采用自动活检枪在彩超引导下进行病理活检。结果：48例穿刺成功,一次成功率为93.8%（45/48）;组织条满意度95.0%;病理检查：乳腺癌17例,乳腺纤维瘤26例,乳腺小叶增生5例,所有患者术后均未发生出血、感染和并发症。结论：彩超引导下自动活检枪穿刺活检,具有穿刺取材安全、准确、快速,可推广应用。     

彩超引导自动活检术诊断浅表小病灶

自动活检枪是一种新型的、先进的组织活检针具,近年来将其与超声显象技术相结合,用于人体多脏器、多部位病变的穿刺活检,取得了令人注目的效果。但该技术用于浅表小病灶活检仍受一定的限制,我们于近两年内对浅表小病灶作彩色超声引导自动活检术(ＣＵＧＡＢ),取得了满意效果。1　资料与方法1.1　临床资料　199701以来本院各科门诊患者40例,年龄6～65岁,其中男12例,女28例。均因体表触及小肿块或因其它病行Ｂ超检查时发现小肿块而作ＣＵＧＡＢ。将位于体表或浅表脏器,肿块距表皮距离≤20ｍｍ、最大径≤20ｍｍ者定为浅表小病灶。本组中肿块距表…     

肾活检124例临床分析

目的 对经皮肾活检的临床意义及并发症进行探讨。方法 在静脉丹盂造影电视荧屏定位下,以Tru-Cut针行肾活检术,标本分送光镜、免疫荧光和电镜检查．现察并发症的发生情况。结果 肾活检后明确诊断120例,穿刺成功率97％。以肾病综合征为临床表现的病理娄型主要为微小病变和局灶节段硬化;以肾炎综合征为临床表现的主要病理类型为系膜增生和IgA肾病;无症状血尿多见于系膜增生和IgA肾病。肾活检的主要并发症为肉眼血尿、肾周血肿和镜下血尿。结论 肾活检对明确诊断、指导治疗有重要意义,但仍需注意出血并发症的发生。     

肾功能衰竭97例肾活检病理资料分析

目的：研究肾功衰竭患者的病理类型及特点。方法：对97例血肌酐≥186 μmoL／L的患者行B超引导下的肾活检术，并对活检组织进行光镜、免疫及电镜检查。结果：硬化性肾炎仅占12．37％，原发性肾小球肾炎占58．。76％，其中IgA肾病22．68％；弥漫系膜增殖性肾炎17．53％；局灶节段性肾小球硬化占11．34％；继发性肾炎占19．59％，以狼疮性肾炎居首位占9．28％；肾小管问质病变占9．28％。结论：对肾功衰竭患者行肾活检有助于了解基础病因及病理类型，从而有利于治疗，延缓肾功衰竭进展。     

1秒钟快速经皮肾活检术（附1507例术后并发症分析）

本文就6年来应用1秒钟快速经皮肾活检术检查1507例次肾脏病人所发生的术后并发症及其影响因素进行分析。 材料和方法 一、临床资料 1983～1988年间,对住院的各类肾脏病1429例进行1507例次肾活检,男964例次,女543例次,平均年龄28.5岁(6～65岁)。肾活检术适应证分别为:尿检异常54.1％、肾病综合征22.8％、肉眼血尿11.2％、慢性肾     

肾活检超微病理诊断1202例分析

在肾活检病理诊断中，电镜下观察肾小球超微结构变化具有重要的作用，本研究收集1202例肾穿进行分析。     

肾活检微波快速处理六胺银染色方法的改进

肾穿刺活检光镜观察肾组织病变进行肾小球疾病诊断和分类的工作中，高质量的六胺银染色（PASM）对诊断具有重要的价值。我科在肾活检标本制作过程中采用微波快速处理组织，结合六胺银染色中组织容易出现过染等问题，利用二次染色的方法进行了改进，介绍如下。     

42例肾错构瘤的CT、彩超对比研究

肾错构瘤为肾脏比较少见的良性肿瘤，准确诊断该肿瘤并与肾恶性肿瘤鉴别对治疗和预后均具有重要临床意义。现就经CT和彩超诊断、手术病理和随访证实的42例报告如下。     

超声引导下徒手法肾组织穿刺活检的应用价值

目的 比较超声引导下徒手肾穿刺活检术与使用穿刺架肾穿刺活检术的优缺点,探讨超声引导下徒手法肾组织穿刺活检的应用价值.方法 使用18G巴德一次性自动活检枪对甲组226例慢性肾病患者行超声引导下徒手肾组织穿刺活检术,乙组261例慢性肾病患者行超声引导下使用穿刺架肾穿刺活检术,按相同的穿刺活检标准决定穿刺部位、穿刺次数,取出的肾组织标本能完成完整的病理诊断,视作活检成功;术中记录穿刺次数,术后观察并发症.结果 甲、乙两组患者平均每例的肾活检穿刺次数各为(2.97±0.43)次和(303±0.72)次、穿刺并发症发生率各为4.9％和2.7％、活检成功率各为98.2％和98.1％,两组间差异均无统计学意义;但两组患者穿刺失败的原因各有不同,使用穿刺架法穿刺失败主要是因为患者特别肥胖或肾脏位置特殊,徒手法穿刺失败主要与穿刺时穿刺枪的稳定性有关.结论 超声引导下徒手法肾穿刺活检术与使用穿刺架法肾穿刺活检术均是安全有效的操作技术;徒手法更适合特别肥胖及某些肾脏位置特殊的患者,可作为使用穿刺架法重要的补充手段.     

超声引导下经皮肾穿刺活检术在慢性肾脏疾病中诊断价值

目的探讨超声引导下经皮肾脏穿刺活检术在诊断慢性肾脏病变中的应用价值。方法对我院94例慢性肾病患者采用超声引导下经皮肾穿刺活检术,取得组织送病理检查;术后观察患者是否有腰痛、腰酸、血尿、肾包膜下血肿等症状,并于第1、2、3天对穿刺患者行彩色多普勒超声检查,观察是否有肾包膜下血肿;查看病理结果,分析超声引导下经皮穿刺肾活检术的成功率。结果 94例行超声引导下经皮肾穿刺活检术的患者均取材成功,取材长度从13~18 mm,根据取材长度穿刺1~3次。穿刺后对患者进行观察,94例患者中有45例患者自述有腰痛、腰酸症状,其中有12例患者有肾包膜下血肿;8例患者出现肉眼血尿,62例患者出现镜下血尿,余患者无明显不适症状。结论超声引导下肾脏穿刺活检术是一种安全有效的辅助检查方法,能提高穿刺的成功率,降低术后并发症,具有较重要的临床应用价值。     

B超引导下经皮肾穿刺活检围手术期的护理

目的：探讨B超引导下经皮肾穿刺活检术前、术中、术后的护理措施。方法：对30例狼疮性肾炎患者行B超下肾穿刺活检，在术前、术中及术后各期进行相应的护理。结果：术后极少部分出现并发症，经相应的对症治疗、护理后，均痊愈。结论：B超引导下的经皮肾穿刺活检术是一种安全准确的诊断技术，但细致周到的护理工作也是穿刺成功的重要保证。     

Lumbar artery pseudoaneurysm following renal biopsy: treatment with ultrasound-guided thrombin injection

latrogenic pseudoaneurysms are usually seen following arterial catheterization. However, we describe a case of a 23-year-old woman who developed a pseudoaneurysm of a lumbar artery following renal biopsy. In view of her progressing renal failure, arterial embolization was felt to be inappropriate, and although the pseudoaneurysm could be seen ultrasonically, guided compression could not be applied because of the location of the aneurysm deep to the lumbar musculature. Hence, the pseudoaneurysm was thrombosed by percutaneous ultrasound-guided injection of thrombin directly into the pseudoaneurysm sac. This resulted in immediate thrombosis of the aneurysm and no recurrence on follow-up imaging. Thrombin injection for femoral artery pseudoaneurysms following catheterization is becoming more widely accepted, and our case demonstrates that this technique might be applied to pseudoaneurysms elsewhere in the body.     

Conventional 15 G needle technique for renal biopsy compared with ultrasound-guided spring-loaded 18 G needle biopsy.

Two techniques for percutaneous renal biopsy were retrospectively reviewed to assess their relative safety and efficacy. Ultrasound localization of the kidney by a radiologists, with subsequent biopsy performed by a renal physician using a hand-held 15 G cutting needle (Tru-Cut), was compared with biopsy performed by a radiologist using an 18 G cutting needle with a spring-loaded biopsy device (Biopty) and real-time ultrasound guidance. The smaller needle with real-time ultrasound is more reliable at retrieving an adequate specimen for histological examination (93%) than the "conventional" technique (79%). Fewer complications occurred in the Biopty group although the difference did not reach statistical significance. The average length of stay in hospital was significantly shorter for elective biopsies with the Biopty device (1.80 compared with 2.93 nights, p less than 0.01). We recommend the use of the Biopty device with an 18 G needle and real-time ultrasound guidance as the method of choice for percutaneous renal biopsy.     

Stereotactic and ultrasound-guided breast biopsy

Percutaneous imaging-guided needle biopsy has increasingly become an alternative to surgical biopsy for the histologic assessment of breast lesions. Percutaneous biopsy is faster, less invasive, and less expensive than surgical biopsy. Tissue acquisition is performed with automated core needles or directional vacuum-assisted biopsy probes. Guidance for percutaneous biopsy is usually provided by stereotaxis, ultrasound, and, more recently, under the guidance of MR imaging. Imaging guidance depends on lesion type and the results of diagnostic imaging studies. This article reviews indications, advantages, limitations, and controversial issues in percutaneous imaging-guided biopsy of breast lesions under stereotactic and ultrasound guidance. The potential for new research opportunities and directions is also discussed.     

超声引导下胸膜活检的操作技巧

目的评价各种操作技巧在超声引导下胸膜活检中的应用价值。方法对150例临床需要胸膜活检的患者应用各种不同的操作技巧进行穿刺活检。对于胸腔积液量少或病程短的患者,活检针应该尽量与肺组织、胸膜呈平行状态;根据胸水量的多少,选择侧卧位或者坐位;标本的处理方面,可将红色的肌肉组织剔除,减少病理取材上的失误。结果根据患者不同情况,采用各种不同的操作技巧进行穿刺活检,肉眼取材成功率100%,病理阳性率76.7%。病理确诊结核95例(63.3%),腺癌20例(13.3%),纤维组织慢性炎27例(18%),纤维骨骼肌8例(5.3%)。病理阳性率76.7%。结论超声引导下胸膜活检应用各种操作技巧非常有必要,能提高取材成功率和病理阳性率。     

超声引导下经皮肾组织活检术的临床应用

目的探讨超声引导下经皮肾穿刺活检的成功率、并发症及其危险因素,并评价其在肾病诊断治疗中的临床应用价值和安全性。方法收集我院200例行经皮肾穿刺活检术患者的临床和病理资料,分析其成功率、并发症、安全性及其治疗修正率问题。结果肾活检成功率100%,肉眼血尿8例（4%）,包膜下血肿2例（1%）。术后均无严重的并发症。结论超声引导自动肾活检,安全可靠,操作简单,对肾脏疾病的早期诊断与治疗有重要意义。     

Transrectal ultrasound-guided biopsy of recurrent cervical carcinoma

The objective of this study was to evaluate the feasibility, safety and diagnostic accuracy of transrectal ultrasound (TRUS)-guided core biopsy for recurrent carcinoma of the uterine cervix in patients with non-diagnostic vaginal cytology and transvaginal punch biopsy.17 patients with clinical and imaging suspicion of recurrent carcinoma of the cervix, and with negative cytology and punch biopsy, were referred for TRUS-guided biopsy of a recurrent mass. Data were collected with respect to demography, previous diagnosis, treatment received, size and location of the recurrent lesion, and biopsy results. Adequate samples were obtained for all patients. TRUS-guided biopsy was technically successful in all of the patients and provided histological diagnosis of recurrence in 16 patients. One of the patients had post-radiation fibrosis. There were no procedure-related complications. In conclusion, TRUS-guided biopsy for recurrent cervical cancer is a feasible, safe and accurate method for establishing a histopathological diagnosis. It should be considered in patients with non-diagnostic vaginal cytology and punch biopsy.     

Electron microscopy of ultrasound-guided fine-needle biopsy specimens

A prospective 3-year study was undertaken in order to assess the value of electron microscopy (EM) as a supplement to routine light microscopy (LM) in ultrasound-guided fine-needle biopsy of suspected abdominal and retroperitoneal tumours. Eight-six of the 899 ultrasound-guided fine-needle biopsies performed during this period were supplemented with EM using the following indications: metastatic lesions with unknown primary tumour, primary retroperitoneal tumours, tumours with atypical clinical histories and where the primary LM evaluation was unable to determine tumour cell type. Two methods of obtaining material for EM were tested, namely, fine-needle aspiration and fine-needle histological biopsy (Surecut). Both methods yielded suitable material for EM evaluation in approximately 80% of the 76 cases where tumour cells were identified by LM. However, it was technically easier to process material for EM when obtained by fine-needle histological biopsy. The results of the 62 cases where suitable material for EM was obtained were grouped according to the histopathological and clinical value of the diagnosis. In 23 cases (37%) EM was without additional diagnostic value. In 12 cases (19%), EM supplied a more precise histopathological diagnosis, but the diagnostic gain was without clinical significance. In 27 cases (44%) EM was of significant clinical value, as the diagnosis by itself was enough to change the investigative procedure and/or the treatment of the patient.