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題 名 | The Role of Ultrasound-Guided Biopsy in Allogeneic Renal Transplant=超音波導引下的移植腎切片術 |
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作 者 | 吳耀銘; 蔡孟昆; 蔡建成; 胡瑞恒; 李伯皇; 張金堅; 李俊仁; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 32:6 民88.11-12 |
頁 次 | 頁252-257 |
分類號 | 415.1461 |
關鍵詞 | 超音波導引; 移植腎切片術; Ultrasound-guided biopsy; Renal allograft; |
語 文 | 英文(English) |
中文摘要 | 急性排斥是引起移植腎功能失常的主要原因,但它的臨床表現常不易與其他引起移植腎功能失常的原因做鑑別診斷;所以需要組織學檢查來做正確診斷及避免過度或不足的使用抗排斥藥物。從1996年十月到1999年三月我們對70個病人做了105次超音波導引下的移植腎切片術。病人跟據使用的切片針大小不同而分成兩組(16號針和18號針)。輕微併發症(9.3%和6.7%)(p=0.659)及正確診斷率(97.4% 和100%)(p=0.366)在這兩組裡面並沒有統計學上的差異存在。但在成功切片率(大於五顆腎小球)(88%和53.3%) (p<0.00l)及平均拿到的腎小球數方面(15.2和6.5)(p<0.00),16號針這一組卻明顯比18 號針這一組還要來的高,且有統計學上的差異存在。病理切片的結果包括:急性排斥69例,慢性排斥或移植腎病變27例,急性腎小管壞死5例,及感染2例。對於急性排斥,我們使用大量類固醇及調節抗排斥藥物;至於其他人則避免使用過度抗排斥藥物。大部分的切片多是在移植後半年內完成。最後我們得到的結論是超音波導引下的移植腎切片術是一個安全而又有效的方法,任何移植腎功能有變差的病人皆應考慮做切片。做切片時使用16號針可獲得足夠的組織以做病理診斷,其併發症亦不高,是一較佳的選擇。 |
英文摘要 | Rejection has been one of the major causes of functional deterioration of renal allografts. Its nonspecific clinical manifestations sometimes make differential diagnosis from other clinical situations fairly difficult. Histological examination was previously necessary to make a definitive diagnosis and was helpful in preventing excessive or inadequate immunosuppression. We performed 105 ultrasound-guided biopsies of renal allografts in 70 patients from November 1996 to March 1999. Patients were divided into two groups according to the size of the Uro-Cut biopsy needle (16-gauge or 18-gauge). The complication rate (9.3% and 6.7%) (p = 0.659) and diagnostic rate (97.4% and 100%) (p = 0.366) showed no statistically significant differences between the two groups. Two patients in the group with 16-gauge needles required repeat biopsies due to insufficient renal tissue being available. The rate of successful biopsies (more than five intact glomeruli ) was statistically higher in the group with 16-gauge needles (88%) than in the group with 18-gauge needles (53.3%) ( P < 0.001). The average number of glomeruli was also statistically higher in the group with 16-gauge needles (15.2) than the group with 18-gauge needles (6.5) ( p < 0.001). The histological findings included 69 episodes of acute rejection, 27 episodes of chronic rejection or allograft nephropathy, 5 episodes of acute tubular necrosis, and 2 cases with infection. Corticosteroid pulse therapy and adjustment of immunosuppression were instituted for 69 episodes of acute rejection. However, excessive immunosuppression was avoided in another 34 episodes of deterioration of graft function which were proven to be other than acute rejection by graft biopsy. More than half of the biopsies of allografts were performed within 6 months after renal transplantation. We conclude that ultrasound-guided renal biopsy in allografts is a safe and effective procedure and should be considered for all patients with deterioration of graft function. It gives timely and adequate immunosuppression for patients with histology-proven acute rejection, and avoids excessive immunosuppression for patients proven otherwise. A 16-gauge Uro-Cut biopsy needle is a suitable device to obtain adequate tissue for histological diagnosis with an acceptable rate of complications. |
本系統中英文摘要資訊取自各篇刊載內容。