Kolb L G, Velosa J A, Bergstralh E J, Offord K P
Division of Nephrology and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Transplantation. 1994 Jun 27;57(12):1742-6.
We retrospectively reviewed all (n = 369) percutaneous renal allograft biopsies performed at our institution between 1987 and 1992, comparing 14-gauge Franklin-Silverman (internal diameter = 2.0 mm, n = 169) and 18-gauge automated (internal diameter = 1.2 mm, n = 200) core biopsy needles. Visualization method, specimen adequacy, and complications were grouped by needle type. Five or more glomeruli were present in 88.9% of specimens obtained with Franklin-Silverman needles and in 82.7% with automated needles. A histologic diagnosis was obtained in 94.1% and 95.5% of Franklin-Silverman and automated biopsies, respectively. A complication was detected in 27 Franklin-Silverman biopsies (16.0%) and in 21 automated biopsies (10.5%) (not significant [NS], P > 0.05). Some procedures had more than one complication. Excluding asymptomatic gross hematuria, incidental hematomas, and incidental arteriovenous fistulas detected by routine ultrasonography, clinically significant complication rates were 6.5% for Franklin-Silverman biopsies and 2.5% for automated biopsies (NS). No allograft losses or patient deaths occurred as a result of allograft biopsy. Subgroup analysis of all biopsies performed with ultrasound marking alone (Franklin-Silverman, n = 119; automated, n = 148) revealed no significant (NS) difference in complication rates (15.1% vs. 10.8%). Additional subgroup analyses of palpation, ultrasound marking, and real-time ultrasonographic visualization techniques within each needle type also revealed no significant difference in the complication rate. Biopsy within 30 days of transplantation and no antihypertensive therapy were the only factors univariately associated (P < 0.05) with an increased complication rate. Multivariate analysis found biopsy within 30 days of transplantation (P = 0.007) was associated with the overall presence of one or more complications of any type. Type of needle (Franklin-Silverman vs. automated) achieved borderline significance (P = 0.047) when time to biopsy was statistically adjusted for; the Franklin-Silverman needle had a higher complication rate.
我们回顾性分析了1987年至1992年间在我院进行的所有（n = 369例）经皮肾移植活检，比较了14号富兰克林 - 西尔弗曼活检针（内径 = 2.0 mm，n = 169例）和18号自动活检针（内径 = 1.2 mm，n = 200例）。根据活检针类型对可视化方法、标本充足性和并发症进行分组。使用富兰克林 - 西尔弗曼活检针获取的标本中，88.9%有5个或更多肾小球，使用自动活检针的标本中这一比例为82.7%。富兰克林 - 西尔弗曼活检和自动活检分别有94.1%和95.5%获得了组织学诊断。27例富兰克林 - 西尔弗曼活检（16.0%）和21例自动活检（10.5%）检测到并发症（无显著性差异[NS]，P>0.05）。一些操作有不止一种并发症。排除无症状肉眼血尿、偶然发现的血肿以及常规超声检查发现的偶然动静脉瘘，富兰克林 - 西尔弗曼活检的临床显著并发症发生率为6.5%，自动活检为2.5%（无显著性差异）。肾移植活检未导致移植肾丢失或患者死亡。仅对仅使用超声标记进行的所有活检进行亚组分析（富兰克林 - 西尔弗曼，n = 119例；自动活检，n = 148例），结果显示并发症发生率无显著差异（15.1%对10.8%）。对每种活检针类型内的触诊、超声标记和实时超声可视化技术进行的其他亚组分析也显示并发症发生率无显著差异。移植后30天内进行活检且未接受抗高血压治疗是仅有的单因素与并发症发生率增加相关（P<0.05）的因素。多变量分析发现移植后30天内进行活检（P = 0.007）与任何类型的一种或多种并发症的总体存在相关。当对活检时间进行统计学调整时，活检针类型（富兰克林 - 西尔弗曼与自动活检针）达到临界显著性（P = 0.047）；富兰克林 - 西尔弗曼活检针的并发症发生率更高。
