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经皮肾活检使用 18 号自动活检针并不理想。

Percutaneous Renal Biopsy Using an 18-Gauge Automated Needle Is Not Optimal.

机构信息

Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.

Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA,

出版信息

Am J Nephrol. 2020;51(12):982-987. doi: 10.1159/000512902. Epub 2021 Jan 15.

Abstract

BACKGROUND

As percutaneous renal biopsies (PRBs) are increasingly performed by radiologists, an increase in the use of 18-gauge automated needle stands to compromise adequacy. We compare the adequacy and safety of PRB with 14-, 16-, and 18-gauge automated needles.

METHODS

PRB of native (N-592) and transplant (T-1,023) kidneys was performed from January 2002 to December 2019 using real-time ultrasound. Baseline clinical and laboratory data, biopsy data (number of cores, total glomeruli, and total glomeruli per core), and outcome (hematoma on renal US at 1-h, complications, and transfusion) were collected prospectively. PRB with N14g (337) versus N16g (255) and T16g (892) versus T18g (131) needles were compared. A p value of <0.05 was significant.

RESULTS

PRB with an 18-g needle yielded the lowest number of total glomeruli per biopsy (N14g vs. N16g: 33 ± 13 vs. 29 ± 12, p < 0.01 and T16g vs. T18g: 34 ± 16 vs. 21 ± 11, p < 0.0001), significantly fewer total glomeruli per core (T16g vs. T18g: 12.7 ± 6.4 vs. 9.6 ± 5.0, p < 0.001 and N16g vs. T18g: 14.2 ± 6.3 vs. 9.6 ± 5.0, p < 0.001). A hematoma by renal US 1-h post-PRB was similar for native (14g-35% vs. 16g-29%, p = 0.2), and transplant biopsies (16g-10% vs. 18g-9%, p = 0.9) and the complication rate for native (14g-8.9% vs. 16g-7.1%, p = 0.5), transplant biopsies (16g-4.6% vs. 18g-1.5%, p = 0.2) and transfusion rate for native (14g-7.7% vs. 16g-5.8%, p = 0.4), and transplant biopsies (16g-3.8% vs. 18g-0.8%, p = 0.1) were similar irrespective of needle size.

CONCLUSIONS

PRB of native and transplant kidneys with the use of a 16-gauge needle provides an optimal sample. However, our experience in transplant biopsies suggests the use of an 18-gauge needle stands to jeopardize the diagnostic accuracy of the PRB while not improving safety.

摘要

背景

随着经皮肾活检(PRB)越来越多地由放射科医生进行,使用 18 号自动针的数量增加可能会影响充分性。我们比较了使用 14 号、16 号和 18 号自动针进行 PRB 的充分性和安全性。

方法

从 2002 年 1 月至 2019 年 12 月,使用实时超声对原发性(N-592)和移植(T-1,023)肾脏进行 PRB。前瞻性收集基线临床和实验室数据、活检数据(活检芯数、肾小球总数和每个活检芯的肾小球总数)以及结果(PRB 后 1 小时肾脏 US 上的血肿、并发症和输血)。比较了使用 N14g(337)与 N16g(255)和 T16g(892)与 T18g(131)针进行 PRB。p 值<0.05 为有统计学意义。

结果

使用 18 号针进行 PRB 得到的每个活检芯的肾小球总数最低(N14g 与 N16g:33 ± 13 与 29 ± 12,p<0.01;T16g 与 T18g:34 ± 16 与 21 ± 11,p<0.0001),每个活检芯的肾小球总数明显减少(T16g 与 T18g:12.7 ± 6.4 与 9.6 ± 5.0,p<0.001;N16g 与 T18g:14.2 ± 6.3 与 9.6 ± 5.0,p<0.001)。PRB 后 1 小时肾脏 US 上的血肿在原发性肾脏(14g-35%与 16g-29%,p=0.2)和移植肾脏活检中相似(16g-10%与 18g-9%,p=0.9),原发性肾脏(14g-8.9%与 16g-7.1%,p=0.5)和移植肾脏活检中并发症发生率(16g-4.6%与 18g-1.5%,p=0.2)和输血率(14g-7.7%与 16g-5.8%,p=0.4)以及移植肾脏活检中相似(16g-3.8%与 18g-0.8%,p=0.1),与针的大小无关。

结论

使用 16 号针进行原发性和移植性肾脏的 PRB 可提供最佳样本。然而,我们在移植性肾脏活检中的经验表明,使用 18 号针可能会影响 PRB 的诊断准确性,而不会提高安全性。

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