Hayatghaibi Shireen E, Ashton Daniel J, Orth Robert C
Department of Radiology, Texas Children's Hospital, 6701 Fannin St., #470, Houston, TX, 77030, USA.
Pediatr Radiol. 2019 May;49(5):626-631. doi: 10.1007/s00247-018-4321-7. Epub 2018 Dec 14.
Percutaneous renal biopsy is a commonly performed procedure that guides decision-making for children with renal disease.
To compare complications from renal biopsies using real-time ultrasound (US) guidance versus pre-procedure US-aided skin-marking in children.
We conducted a priori power analysis using a risk-adjusted model, which indicated we needed a sample size of 643-714 procedures (effect size: 0.8). Then we retrospectively identified consecutive patients who underwent a percutaneous renal biopsy from Jan. 1, 2012, to Dec. 31, 2016. We categorized complications according to the Society of Interventional Radiology (SIR) criteria and compared rates using the Fisher exact test. We analyzed complication predictors using multivariate regression.
The study consisted of 701 percutaneous renal biopsies in 553 patients: 313 used real-time US guidance and 388 used pre-procedure US-aided skin-marking. Among the 254/701 (36%) complications, 56/313 (18%) resulted from real-time US guidance and 198/388 (51%) from pre-procedure US-aided skin-marking (P<0.001). In the US real-time guidance group, 39/56 (70%) complications were SIR A, 8/56 (14%) SIR B, 6/56 (11%) SIR C and 3/56 (5%) SIR D. Among the pre-procedure US-aided skin-marking group, 139/198 (70%) complications were SIR A, 47/198 (24%) SIR B, 11/198 (6%) SIR C and 1/198 (1%) SIR D. Complications between the two groups were significantly different regarding SIR A (P<0.001) and SIR B complications (P<0.001) but not major complications. Multivariate regression demonstrated that complications were higher using US-aided pre-procedure skin-marking (odds ratio [OR]=6.30; 95% confidence interval [CI]=3.86, 10.27) than with US real-time guidance.
Children and young adults who underwent real-time US-guided percutaneous renal biopsies had significantly fewer minor complications, including those requiring follow-up medical care, compared to those who underwent percutaneous renal biopsies with pre-procedure US-aided skin-marking. No difference was detected in the incidence of major complications.
经皮肾活检是一项常用于指导肾病患儿决策的操作。
比较儿童经皮肾活检采用实时超声（US）引导与术前US辅助皮肤标记的并发症情况。
我们使用风险调整模型进行了先验功效分析，结果表明我们需要643 - 714例操作的样本量（效应量：0.8）。然后我们回顾性地确定了2012年1月1日至2016年12月31日期间连续接受经皮肾活检的患者。我们根据介入放射学会（SIR）标准对并发症进行分类，并使用Fisher精确检验比较发生率。我们使用多因素回归分析并发症的预测因素。
该研究包括553例患者的701例经皮肾活检：313例采用实时US引导，388例采用术前US辅助皮肤标记。在254/701（36%）例并发症中，实时US引导组有56/313（18%）例，术前US辅助皮肤标记组有198/388（51%）例（P<0.001）。在US实时引导组中，39/56（70%）例并发症为SIR A级，8/56（14%）例为SIR B级，6/56（11%）例为SIR C级，3/56（5%）例为SIR D级。在术前US辅助皮肤标记组中，139/198（70%）例并发症为SIR A级，47/198（24%）例为SIR B级，11/198（6%）例为SIR C级，1/198（1%）例为SIR D级。两组之间在SIR A级并发症（P<0.001）和SIR B级并发症（P<0.001）方面有显著差异，但在主要并发症方面无差异。多因素回归分析表明，与US实时引导相比，术前US辅助皮肤标记的并发症发生率更高（优势比[OR]=6.30；95%置信区间[CI]=3.86, 10.27）。
与采用术前US辅助皮肤标记进行经皮肾活检的儿童和年轻人相比，接受实时US引导经皮肾活检的儿童和年轻人的轻微并发症（包括需要后续医疗护理的并发症）明显更少。主要并发症的发生率未发现差异。
