CAJ | 학술논문

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.
목적 비교수직진침화45°사향하진침시경피신활검적취재질량화안전성.방법 회고성도시핵공업사일륙의원신내과2003년4월지2012년4월203례초성인도하경피신활검환자적림상자료,근거진침방향장환자분위2조:수직진침조(A조)79례,45°사향하진침조(B조)124례.비교분석2조환자취재질량(단차취재장도、절편포함신소구수균치화취중피수교계처환자비례)화안전성(피하혈종발생솔、경하혈뇨발생솔、혈홍단백하강환자비례).결과 량조단차취재장도적차이무통계학의의[(0.89±0.09)cm비(1.08±0.05)cm,P＞0.05].B조절편중신소구수[(24±4)개비(15±6)개,P＜0.05]급취중피수교계처환자비례다우A조[67.7％(84/124)비17.7％ (14/79),P＜0.01].B조경하혈뇨발생솔[23.4％ (29/124)비37.9％ (30/79)]화혈홍단백하강비례[4.8％ (6/124)비15.2％ (12/79)]균저우A조(균P＜0.05),량조피하혈종적발생솔차이무통계학의의(P＞0.05).결론 45°사향하진침불부가제고신활검적취재질량,환재일정정도상감소료기병발증적발생솔.
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.