超声引导下经皮肾造瘘对肾结核孤立肾输尿管梗阻的疗效观察

doi:10.3877/cma.j.issn.1672-6448.2021.07.016

目的

总结超声引导经皮穿刺肾造瘘对肾结核孤立肾肾盂积水治疗的效果。

方法

选取2011年1月至2019年7月在解放军总医院第八医学中心收治的27例肾结核孤立肾肾积水患者，行超声引导下经皮造瘘置管留置，统计置管及换管成功率、并发症，采用t检验比较置管前后血清肌酐变化差异，调查长期带管对患者生活的影响。

结果

27例患者共行置管穿刺55人次，穿刺置管成功率100%（55/55）。穿刺后少量出血占92.7%（51/55），中等量出血占5.5%（3/55），严重出血占1.8%（1/55）。更换造瘘管361次，更换成功率92.2%（333/361）。置管后血清肌酐下降［（206.4±17.0）μmol/L vs （426.0±50.7）μmol/L］，差异具有统计学意义（t=5.286，P＜0.001）。77.8%（21/27）的患者带管可参加轻体力劳动或日常工作，全部患者生活可自理。

结论

超声引导下经皮肾造瘘，操作简便，创伤小，长期带管可以作为肾结核孤立肾肾盂积水治疗的方法，但远期疗效仍在观察之中。

关键词: 超声, 肾结核, 输尿管梗阻, 肾造瘘

Objective

To assess the efficacy of ultrasound-guided percutaneous nephrostomy for the treatment of patients with single tuberculous kidney with obstructive ureter.

Methods

Between January 2011 and July 2019, 27 patients who received nephrectomy of one non-functioning tuberculous kidney and had a single tubercuous kidney with obstructive ureter underwent percutaneous nephrostomy under ultrasound guidance at the Department of Ultrasound of the Eighth Medical Center of Chinese PLA General Hospital. The successful rates of punctures and replacement of drainage tube and relevant complications were investigated. Plasma creatinine pre- and post-percutaneous nephrostomy was compared by t-test. Patients' life quality after percutaneous nephrostomy was investigated.

Results

The successful rate was 100% (55/55) in 55 one-step punctures in 27 patients. Mild bleeding occurred in 92.7% (51/55) of cases, moderate bleeding in 5.5% (3/55), and severe bleeding in 1.8% (1/55). A total of 361 catheter replacements were performed, and the successful rate was 92.2% (333/361). A significant decrease of plasma creatinine was found after percutaneous nephrostomy [(206.4±17.0) μmol/L vs (426.0±50.7) μmol/L; t=5.286, P＜0.001]. All patients could self-care themselves and 21 (77.8%) patients could complete their routine work.

Conclusion

Ultrasound-guided percutaneous nephrostomy is easy to perform, less invasive, and effective for the treatment of patients with single tuberculous kidney with obstructive ureter. The long-term results remain to be investigated.

Key words: Ultrasound, Tuberculous kidney, Obstructive ureter, Percutaneous nephrostomy

图1 男性，44岁，确诊双肾结核15个月，抗结核治疗12个月，左肾切除右肾积水。图a灰阶超声显示输尿管（↑）肾盂（▲）积水；图b彩色多普勒选择穿刺路径；图c选择肾乳头部位穿刺进针（↑）

图2 27例置管患者置管前后血浆肌酐变化图

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Efficacy of ultrasound-guided percutaneous nephrostomy for patients with single tuberculous kidney with obstructive ureter

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Efficacy of ultrasound-guided percutaneous nephrostomy for patients with single tuberculous kidney with obstructive ureter