Johnson Scott, Fiscus Gabriel, Sudakoff Gary S, O'Connor R Corey, Guralnick Michael L
Department of Urology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Can J Urol. 2013 Aug;20(4):6840-3.
To evaluate the use of ultrasound (US) at the time of percutaneous suprapubic catheter (SPC) placement. US has been recommended as a way to minimize complications, such as bowel injury, during percutaneous SPC placement, yet there is limited data supporting this recommendation.
A retrospective chart review was performed on patients undergoing percutaneous SPC placement from 2002 to 2011. The method of percutaneous SPC placement (cystoscopic and/or ultrasound guidance, blind) was recorded and patients were subdivided into groups based on the use of US. The need to modify the approach based on US findings and complications such as bleeding or bowel injury were noted and compared between groups.
A total of 307 percutaneous SPCs were placed: cystoscopy alone was used in 190 (62%) patients, cystoscopy + US in 86 (28%) patients, US alone in 6 (2%) patients, and 25 (8%) patients had the SPC placed blindly. Previous lower abdominal surgery was noted in 41/92 (45%) of patients with and 32/215 (15%) of patients without US usage. US identified intervening loops of bowel in 5/92 cases (5%), all of whom had a history of lower abdominal surgery. The approach was modified in 2/5 and abandoned in 3/5 based on US findings. Postoperative bleeding occurred in 1/215 (0.5%) of patients with and 1/92 (1%) of patients without US usage. No bowel injuries occurred.
While US may not be needed in most patients, particularly when cystoscopy is used, it may help to avoid bowel injury in patients with a history of lower abdominal surgery.
评估经皮耻骨上膀胱造瘘术（SPC）置管时超声（US）的应用。超声已被推荐为一种在经皮SPC置管过程中尽量减少并发症（如肠损伤）的方法，但支持该推荐的数据有限。
对2002年至2011年接受经皮SPC置管的患者进行回顾性病历审查。记录经皮SPC置管的方法（膀胱镜检查和/或超声引导、盲插），并根据超声的使用情况将患者分为几组。记录根据超声检查结果修改置管方法的必要性以及出血或肠损伤等并发症，并在组间进行比较。
共进行了307例经皮SPC置管：190例（62%）患者仅采用膀胱镜检查，86例（28%）患者采用膀胱镜检查+超声，6例（2%）患者仅采用超声，25例（8%）患者为盲插。有41/92（45%）例使用超声的患者和32/215（15%）例未使用超声的患者有既往下腹部手术史。超声在5/92例（5%）病例中发现有肠袢，所有这些患者都有下腹部手术史。根据超声检查结果，2/5的病例修改了置管方法，3/5的病例放弃了原方法。术后出血在未使用超声的患者中为1/215（0.5%），在使用超声的患者中为1/92（1%）。未发生肠损伤。
虽然大多数患者可能不需要超声，尤其是在使用膀胱镜检查时，但超声可能有助于避免有下腹部手术史患者发生肠损伤。
