超声-DSP融合引导PCN在复杂性肾积水优于CT引导
结果显示超声-DSP融合组手术时间更短、穿刺次数更少、二期输尿管镜成功率更高。融合组辐射剂量与直接医疗费用均显著降低，且并发症未增加。
要点
- 复杂性肾积水急诊PCN可优先考虑超声-DSP融合引导的一站式方案。
- 超声-DSP融合引导较CT引导辐射剂量降低58%，直接费用降低19.3%。
- 融合组二期输尿管镜成功率93.3%，高于CT组的75.0%。
核心结论
- 超声-DSP融合引导的一站式PCN在复杂性肾积水中优于CT引导的分期PCN，可提高操作效率并有利于后续治疗。
- 该方案显著减少辐射暴露和医疗费用，支持其作为首选方法。
研究设计与样本
- 回顾性倾向评分匹配多中心队列研究，纳入2022至2023年接受急诊PCN的复杂性肾积水患者。
- 复杂性肾积水定义为Society for Fetal Urology分级≥3级和/或合并解剖或恶性因素。
- 主要终点为手术时间、穿刺次数和2周二期输尿管镜成功率；次要终点包括减压效果、30天并发症、直接医疗费用和辐射剂量。
诊断标准与关键数值
- 超声-DSP融合组中位手术时间22.2分钟，较CT组35.6分钟缩短38%（P<.001）。
- 超声-DSP融合组平均穿刺次数1.7次，少于CT组2.2次（P=.005）。
- 超声-DSP融合组单次穿刺成功率65.0%，高于CT组38.3%（P=.003）。
- 超声-DSP融合组二期输尿管镜成功率93.3%，高于CT组75.0%（P=.002）。
- 超声-DSP融合组中位辐射剂量9.2mSv，较CT组22.0mSv降低58%（P<.001）。
临床应用与阅片要点
- 对复杂性肾积水需急诊PCN时，超声-DSP融合引导可作为替代CT引导的高效方案。
- 该方案可减少穿刺次数并提高单次穿刺成功率，有助于降低反复穿刺相关风险。
- 更高的二期输尿管镜成功率提示融合引导可能更有利于后续上尿路处理。
- 融合引导可显著降低患者辐射暴露，对需反复介入操作的患者更有价值。
局限性
- 本研究为回顾性设计，存在选择偏倚和信息偏倚风险。
- 倾向评分匹配虽可平衡已知混杂因素，但无法控制未知混杂因素。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
AIM: To compare the procedural efficiency, clinical outcomes, and economic impact of one-stop US-DSP (ultrasound-digital subtraction pyelography) fusion-guided percutaneous nephrostomy (PCN) versus conventional staged CT-guided PCN for complex hydronephrosis.
MATERIALS AND METHODS: This retrospective, propensity-score matched, multicenter study included consecutive patients with complex hydronephrosis (Society for Fetal Urology grade ≥3 and/or complicated by anatomical/malignant factors) who underwent urgent PCN between 2022 and 2023. Patients were stratified by guidance method (US-DSP fusion vs. CT) and matched 1:1. Primary endpoints were procedural time, number of needle passes, and 2-week secondary ureteroscopy success rate. Secondary outcomes included decompression efficacy, 30-day complications, direct medical costs, and radiation dose.
RESULTS: Sixty matched patient pairs were analyzed. The US-DSP fusion group showed superior performance: 38% shorter median procedural time (22.2 vs. 35.6 min, P<.001), fewer needle passes (1.7 vs. 2.2, P=.005), higher single-pass success rate (65.0% vs. 38.3%, P=.003), and higher secondary ureteroscopy success rate (93.3% vs. 75.0%, P=.002). It also reduced median radiation dose by 58% (9.2 vs. 22.0 mSv, P<.001) and direct costs by 19.3% (¥5,862 vs. ¥7,266, P<.001), without increasing complications (5.0% vs. 10.0%, P=.310).
CONCLUSION: US-DSP fusion-guided one-stop PCN outperforms CT-guided staged PCN for complex hydronephrosis, enhancing efficiency, facilitating downstream treatment, and reducing radiation exposure and costs, supporting its adoption as the preferred approach.
引用
- Shen, Li, Wang, et al. Superiority of ultrasound-DSP fusion over CT guidance for percutaneous nephrostomy in complex hydronephrosis: a propensity-matched multicenter cohort study demonstrating enhanced procedural efficiency and secondary ureteroscopy success. Clin Radiol. 2026. PMID: 42229072. doi:10.1016/j.crad.2026.107376
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。