经肾内科医生到介入放射科医生行经皮肾活检术操作表现的变化趋势：单中心经验。

Changing Trends in the Performance of Percutaneous Renal Biopsy from Nephrologist to Interventional Radiologist: A Single-Center Experience.

出版信息

Am J Nephrol. 2018;48(5):326-329. doi: 10.1159/000493925. Epub 2018 Oct 24.

Abstract

BACKGROUND

Percutaneous renal biopsy of native kidneys (PRB) has been an integral part of the practice of nephrology. However, over the past 30 years, PRB has transitioned from a procedure performed only by nephrologists to interventional radiologists (IRs). We surveyed practicing nephrologists completing training in our program to determine the clinical practice patterns of PRB.

METHODS

The 78 fellows completing the nephrology program at Rush University Medical Center from June 1984 through June 2017 were successfully contacted and surveyed regarding their opinion on adequacy of their training and whether they performed PRB in practice and if not or no longer, why. To evaluate for differences in the performance of PRB over time, a comparison of 4 periods of fellowship completion (i.e., 1984-1990, 1991-2000, 2001-2010, 2011-2017) was performed.

RESULTS

All 78 nephrologists felt they had been adequately trained to perform PRB. PRB was performed by 45 (58%) nephrologists post-fellowship, but a significant decline was observed over the 4 periods of time from 1984 to 2017 (100 vs. 86 vs. 52 vs. 20%, p < 0.0001). The primary reason that 33 nephrologists did not perform PRB was that it was too time consuming and IR was available to perform PRB. Of the 71 nephrologists still in practice only 12 (17%) continue to perform PRB. A greater proportion of nephrologists completing training from 1984-1990 continue to perform PRB relative to those trained after 1990. The universal reason that nephrologists were no longer performing PRB was again an issue of time and the fact that IRs were available to perform PRB.

CONCLUSION

We find that there has been a significant transition over time in the performance of PRB by a nephrologist to IR. The major reason for this is the time burden associated with PRB and the availability of IRs.

摘要

背景

经皮肾活检（PRB）一直是肾脏病学实践的重要组成部分。然而，在过去的 30 年中，PRB 已经从仅由肾脏病医生进行的手术转变为介入放射科医生（IR）。我们调查了在我们的项目中完成培训的执业肾脏病医生，以确定他们进行 PRB 的临床实践模式。

方法

成功联系并调查了 1984 年 6 月至 2017 年 6 月期间在拉什大学医学中心完成肾脏病学项目的 78 名研究员，了解他们对培训是否充分的看法，以及他们是否在实践中进行 PRB，如果没有或不再进行，原因是什么。为了评估随着时间的推移进行 PRB 的差异，对四个时间段（即 1984-1990 年、1991-2000 年、2001-2010 年和 2011-2017 年）完成的研究员进行了比较。

结果

所有 78 名肾脏病医生都认为他们接受了充分的 PRB 培训。45 名（58%）研究员在完成研修后进行了 PRB，但从 1984 年到 2017 年，这一比例显著下降（100%比 86%比 52%比 20%，p < 0.0001）。33 名肾脏病医生不进行 PRB 的主要原因是时间过长，而且有 IR 可以进行 PRB。在 71 名仍在执业的肾脏病医生中，只有 12 名（17%）继续进行 PRB。从 1984-1990 年完成培训的肾脏病医生继续进行 PRB 的比例相对高于 1990 年以后完成培训的医生。肾脏病医生不再进行 PRB 的普遍原因是与 PRB 相关的时间负担以及 IR 可进行 PRB。