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目的评价、分析儿童肾活检的安全性、成功率及并发症。方法肾脏病患儿100例在B超引导下经皮穿刺活检,用20g/L利多卡因逐层局部麻醉至肾包膜,不能配合者应用氯硝西泮,镇静后进行。B超定位后,用皮钻或手术刀片于穿刺点皮肤切开0·3～0·5cm切口,在B超监视下将穿刺针逐层进针到达肾脏被膜时,在平静呼吸时嘱患儿屏住呼吸(肾脏位置较高的患儿需深吸气后屏住呼吸),开枪切割,快速拔出穿刺针。术者用手掌压迫穿刺部位10～15min,腹带、沙袋加压包扎。结果99例获得足够肾组织,平均肾小球7～52个[(23.1±12.1)个],满足了光镜、电镜、免疫荧光三镜的需要,并作出完整的病理诊断,1例虽穿刺成功,但全为髓质组织,无肾小球,总成功率99%。其主要并发症:均有疼痛,一过性肉眼血尿3/100例,腰部不适15/100例。无肾周血肿、感染、休克等严重并发症发生。结论超声引导下经皮儿童肾活检安全可靠,成功率高,并发症少,其病理诊断对临床治疗及预后评价具有明确的指导意义。
Objective To evaluate and analyze the safety, success rate and complications of renal biopsy in children. Methods 100 cases of children with kidney disease under the guidance of B-ultrasound percutaneous biopsy, with lidocaine 20g / L local anesthesia to the renal capsule, can not cooperate with clonazepam, after the sedation. B ultrasound positioning, with a leather drill or surgical blade at the puncture point skin incision 0.3-3.5cm incision, under the B-monitoring the needle into the kidney layer by layer into the needle when the kidneys in the calm breathing Hold your breath (kidneys with higher kidneys need to hold their breath after a deep inspiration), shoot and cut, and quickly pull out the puncture needle. Surgery with the palm of the hand pressing the puncture site 10 ~ 15min, abdominal bandage, sandbags pressure bandage. Results 99 cases of adequate kidney tissue, the average glomerular 7 to 52 [(23.1 ± 12.1)], to meet the light microscope, electron microscopy, immunofluorescence three mirror needs and make a complete pathological diagnosis, although one puncture Success, but all for the medullary tissue, no glomerular, the total success rate of 99%. The main complications: all have pain, transient gross hematuria 3 100 cases, waist discomfort 15/100 cases. No perirenal hematoma, infection, shock and other serious complications. Conclusion Ultrasound-guided percutaneous renal biopsy is safe and reliable with high success rate and few complications. Its pathological diagnosis has clear guiding significance for clinical treatment and prognosis evaluation.