Robert M, Delbos O, Faure F, Chong G, Iborra F, Mourad G, Guiter J
Service d'Urologie, Hôpital Lapeyronie, Montpellier.
Prog Urol. 1995 Jun;5(3):377-83.
To evaluate the morbidity of renal transplant biopsies performed after simple ultrasonographic identification of the transplants, using a Vim-Silverman or Tru-cut needle.
From January 1987 to April 1991, 360 renal transplant biopsies were performed after simple ultrasonographic identification of the transplants, using a Vim-Silverman (n = 204) or Tru-cut (n-156) needle. In 221 transplants, these biopsies were performed because of a rise of serum creatinine (n = 319) or proteinuria (n = 17) or were even performed systematically (n = 24). One to 5 (mean = 1.6) transplant biopsies were performed systematically and the interval between renal transplantation and biopsy varied between 3 days and 11 years.
290 biopsies (80.6%) allowed the analysis of a minimum of 3 glomeruli (mean = 9.3). The yield of the Vim-Silverman needle was significantly greater than that of the Tru-cut model (p = 0.02). 147 biopsies (50.7%) demonstrated acute or chronic rejection, 57 (19.7%) revealed cyclosporin nephrotoxicity, 41 (14.1%) showed acute tubular necrosis and 14 (4.8%) showed glomerulopathy, while 31 (10.7%) were strictly normal. The morbidity of these biopsies was reflected by 37 complications (10.3%), including 30 minor and 7 major complications (2 cases of haemoperitoneum, 4 cases of obstructive anuria and 1 arteriovenous fistula). However, only one case required transplantectomy. These problems were significantly more frequent following inadequate biopsies (< 3 glomeruli, purely medullary, extra-renal).
Despite the considerable risk of iatrogenic lesions, these biopsies were justified by their potential diagnostic and therapeutic benefit. The prophylaxis of complications of this procedure is based on strict respect of blood pressure and haematological criteria and on real-time ultrasound monitoring of the biopsy and miniaturization of the trocars. The treatment of severe complications has been greatly improved by the development of endourology and interventional radiology, but surgery, and especially transplantectomy, is still occasionally required.
使用Vim-Silverman针或Tru-cut针，评估在单纯超声识别移植肾后进行肾移植活检的发病率。
1987年1月至1991年4月，在单纯超声识别移植肾后，使用Vim-Silverman针（n = 204）或Tru-cut针（n = 156）进行了360例肾移植活检。在221例移植肾中，进行这些活检的原因是血清肌酐升高（n = 319）或蛋白尿（n = 17），甚至是系统性进行的（n = 24）。系统性地进行了1至5次（平均 = 1.6次）移植肾活检，肾移植与活检之间的间隔时间在3天至11年之间。
290例活检（80.6%）能够分析至少3个肾小球（平均 = 9.3个）。Vim-Silverman针的取材成功率显著高于Tru-cut针（p = 0.02）。147例活检（50.7%）显示急性或慢性排斥反应，57例（19.7%）显示环孢素肾毒性，41例（14.1%）显示急性肾小管坏死，14例（4.8%）显示肾小球病变，而31例（10.7%）完全正常。这些活检的发病率通过37例并发症（10.3%）反映出来，包括30例轻微并发症和7例严重并发症（2例腹腔内出血、4例梗阻性无尿和1例动静脉瘘）。然而，只有1例需要进行移植肾切除术。活检取材不充分（< 3个肾小球、纯髓质、肾外）后，这些问题明显更常见。
尽管存在相当大的医源性损伤风险，但这些活检因其潜在的诊断和治疗益处而合理。该操作并发症的预防基于严格遵守血压和血液学标准，以及对活检进行实时超声监测和套管针小型化。随着腔内泌尿外科和介入放射学的发展，严重并发症的治疗有了很大改善，但手术，尤其是移植肾切除术，偶尔仍有必要。
