【摘要翻译】《Am J Kidney Dis》经皮穿刺禁忌患者可接受经颈静脉肾穿刺
发布于 2004-05-10 · 浏览 1046 · IP 湖南湖南
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Am J Kidney Dis. 2004 Apr;43(4):651-62.
Transjugular kidney biopsy.
Thompson BC, Kingdon E, Johnston M, Tibballs J, Watkinson A, Jarmulowicz M, Burns A, Sweny P, Wheeler DC.
Centre for Nephrology, Department of Radiology, and Department of Histopathology, Royal Free Hospital, London, United Kingdom. sbjbi@hotmail.com
BACKGROUND: Most previous studies demonstrating the feasibility of transjugular kidney biopsy have used a modified Colapinto aspiration biopsy needle. We present 25 high-risk patients, with contraindications to percutaneous renal biopsy, who underwent transjugular kidney biopsy using a transvenous side-cut needle. This technique is easier to learn and can be performed by an interventional radiologist with transjugular liver biopsy experience and equipment. The needle is designed for optimal cortical sampling but has a high incidence of capsular perforation. Elective coil embolization was used in selected patients to reduce the risk of bleeding. METHODS: We retrospectively reviewed the indications for obtaining renal histology, based on clinical presentation, and the specific indications for transjugular biopsy. Transjugular kidney biopsy was assessed for sampling effectiveness and adequacy, the impact of histology on patient management, and technique complication rates. RESULTS: Renal tissue was obtained in 23 cases, with diagnostic biopsies in 21 of 23 (91.3%). A mean of 3.5 cores were obtained with 9.9 glomeruli per procedure for light microscopy (range, 0 to 32), 2.2 (range, 1 to 7) for electron microscopy, and adequate tissue for immunoflorescence available in 11 of 23 biopsies. Histology influenced patient management in all 23 cases. Capsular perforation was recorded in 73.9% (17 of 23) of cases with 6 undergoing elective coil embolization. Two major complications occurred, both in patients with multiple risk factors for bleeding. One required coil embolization of an arterio-calyseal system fistula. A further patient developed renal vein thrombosis 6 days after a failed transjugular kidney biopsy. CONCLUSION: Transjugular kidney biopsy provides a histological diagnosis in high-risk patients, making an important contribution to patient management.
经皮穿刺禁忌患者可接受经颈静脉肾穿刺
英国伦敦皇家医院Thompson等在Am J Kidney Dis（2004，43，651）上报告，在有经皮肾穿刺禁忌证的患者中，经颈静脉入路不失为一种可行的替代方法。
研究人员应用套管活检穿刺针为２５例有高度出血危险、禁忌经皮穿刺的患者进行了经颈静脉肾穿刺，顺利地获取了２３例患者的肾组织（２例患者因肾静脉插管困难而失败），且这些患者的临床治疗都因其肾穿刺组织学结果而获益。经颈静脉肾穿刺最常见的不良反应为肾囊穿孔，发生率为７３．９％（１７例），仅２例有多种出血危险因素的患者发生了大出血。
Transjugular kidney biopsy.
Thompson BC, Kingdon E, Johnston M, Tibballs J, Watkinson A, Jarmulowicz M, Burns A, Sweny P, Wheeler DC.
Centre for Nephrology, Department of Radiology, and Department of Histopathology, Royal Free Hospital, London, United Kingdom. sbjbi@hotmail.com
BACKGROUND: Most previous studies demonstrating the feasibility of transjugular kidney biopsy have used a modified Colapinto aspiration biopsy needle. We present 25 high-risk patients, with contraindications to percutaneous renal biopsy, who underwent transjugular kidney biopsy using a transvenous side-cut needle. This technique is easier to learn and can be performed by an interventional radiologist with transjugular liver biopsy experience and equipment. The needle is designed for optimal cortical sampling but has a high incidence of capsular perforation. Elective coil embolization was used in selected patients to reduce the risk of bleeding. METHODS: We retrospectively reviewed the indications for obtaining renal histology, based on clinical presentation, and the specific indications for transjugular biopsy. Transjugular kidney biopsy was assessed for sampling effectiveness and adequacy, the impact of histology on patient management, and technique complication rates. RESULTS: Renal tissue was obtained in 23 cases, with diagnostic biopsies in 21 of 23 (91.3%). A mean of 3.5 cores were obtained with 9.9 glomeruli per procedure for light microscopy (range, 0 to 32), 2.2 (range, 1 to 7) for electron microscopy, and adequate tissue for immunoflorescence available in 11 of 23 biopsies. Histology influenced patient management in all 23 cases. Capsular perforation was recorded in 73.9% (17 of 23) of cases with 6 undergoing elective coil embolization. Two major complications occurred, both in patients with multiple risk factors for bleeding. One required coil embolization of an arterio-calyseal system fistula. A further patient developed renal vein thrombosis 6 days after a failed transjugular kidney biopsy. CONCLUSION: Transjugular kidney biopsy provides a histological diagnosis in high-risk patients, making an important contribution to patient management.
经皮穿刺禁忌患者可接受经颈静脉肾穿刺
英国伦敦皇家医院Thompson等在Am J Kidney Dis（2004，43，651）上报告，在有经皮肾穿刺禁忌证的患者中，经颈静脉入路不失为一种可行的替代方法。
研究人员应用套管活检穿刺针为２５例有高度出血危险、禁忌经皮穿刺的患者进行了经颈静脉肾穿刺，顺利地获取了２３例患者的肾组织（２例患者因肾静脉插管困难而失败），且这些患者的临床治疗都因其肾穿刺组织学结果而获益。经颈静脉肾穿刺最常见的不良反应为肾囊穿孔，发生率为７３．９％（１７例），仅２例有多种出血危险因素的患者发生了大出血。
最后编辑于 2004-06-20 · 浏览 1046
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