Feneberg R, Schaefer F, Zieger B, Waldherr R, Mehls O, Schärer K
Division of Pediatric Nephrology, University of Heidelberg, Germany.
Nephron. 1998 Aug;79(4):438-46. doi: 10.1159/000045090.
The introduction of automated biopsy devices and the localization of the kidney by ultrasound were aimed at optimizing efficacy and safety of the percutaneous renal biopsy procedure. We evaluated these technological advances in our renal biopsies performed in children.
We sequentially used the Silverman needle (1969-1974), the TruCut needle (1974-1990), and the automated Biopty device (1990-1996). Fluoroscopy was used to localize the kidney until 1985, ultrasound examination prior to biopsy from 1985 to 1992, and direct ultrasound guidance since 1992. A total of 962 native kidney biopsies and 119 allograft biopsies were performed.
In the native kidney biopsies, the introduction of the Biopty device and ultrasound guidance were independently associated with fewer passes required to obtain adequate tissue and more glomeruli per specimen. The rate of biopsies yielding more than 9 glomeruli increased from 69 to 92% (p < 0.05). The number of glomeruli harvested per centimeter core length was inversely related to patient age (p < 0.01). More appropriate cortical tissue was retrieved in renal allograft biopsy specimens with the application of the new techniques. The occurrence of macroscopic hematuria (9. 6%) in the native kidney biopsies was not affected by the puncture or localization technique applied, but subcapsular hematomas were documented more often with the Biopty device (42%) than with the TruCut needle (16%), probably due to improved ultrasound equipment. In the whole series 2 patients died, and 3 others required renal surgery and 4 blood transfusions.
The automated ultrasound-guided procedure is a feasible and reliable technique for percutaneous renal biopsy in children. It gives a greater yield of diagnostic tissue without increasing the rate of clinical complications.
引入自动活检装置并通过超声对肾脏进行定位，旨在优化经皮肾活检术的有效性和安全性。我们评估了这些技术进步在儿童肾活检中的应用情况。
我们依次使用了西尔弗曼针（1969 - 1974年）、TruCut针（1974 - 1990年）和自动活检装置Biopty（1990 - 1996年）。1985年以前使用荧光镜对肾脏进行定位，1985年至1992年在活检前进行超声检查，自1992年起采用直接超声引导。共进行了962例自体肾活检和119例同种异体肾活检。
在自体肾活检中，Biopty装置的引入和超声引导与获取足够组织所需的穿刺次数减少以及每个标本中肾小球数量增多独立相关。产生超过9个肾小球的活检率从69%提高到92%（p < 0.05）。每厘米芯长获取的肾小球数量与患者年龄呈负相关（p < 0.01）。应用新技术后，同种异体肾活检标本中获取了更合适的皮质组织。自体肾活检中肉眼血尿的发生率（9.6%）不受所应用的穿刺或定位技术影响，但使用Biopty装置记录到的包膜下血肿发生率（42%）高于TruCut针（16%），这可能是由于超声设备的改进。在整个系列中，2例患者死亡，另外3例需要进行肾脏手术，4例需要输血。
自动超声引导下的操作是儿童经皮肾活检的一种可行且可靠的技术。它能获得更多用于诊断的组织，而不增加临床并发症的发生率。
