Goharderakhshan R Z, Schwartz B F, Rudnick D M, Irby P B, Stoller M L
Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, California, USA.
Urology. 2001 Nov;58(5):693-6. doi: 10.1016/s0090-4295(01)01359-0.
To compare the radial and axial forces produced by balloon, Amplatz, and radially expanding single-step nephrostomy (RESN) systems and report our initial clinical results using the new RESN device. Balloon, Amplatz, and Alken dilators are commonly used to establish nephrostomy tracts in percutaneous surgery. They require multiple steps, with the potential for kinking and displacement of the working guidewire. In contrast, the new RESN tract dilator expands a unique sleeve conduit and places an Amplatz-like sheath in a single step with less dependence on a guidewire for dilation.
An experimental model was designed using a perforated silicon disc with a 10F central opening to measure the axial force transmission as 30F balloon, Amplatz, and RESN systems were inserted through the silicon discs. We also report our first 9 patients who underwent percutaneous dilation with the RESN system.
Thirty French expansion was achieved with each dilator tested. Substantially lower axial forces were transmitted with the RESN device compared with the balloon and Amplatz dilators (5.2 versus 13.1 and 19.2 lb, respectively, P <0.001). Intraoperatively, all 9 patients were successfully dilated, and the kidney was relatively stationary as imaged with fluoroscopy. One patient with multiple prior renal procedures was successfully dilated with RESN system after failed attempts with balloon dilation.
The RESN dilator is a rapid, single-step access system successfully used in our first 9 patients. Intraluminal sleeve dilation eliminates guidewire dependence for maintaining access, limits renal displacement, and facilitates appropriate vector force for percutaneous dilation.
比较球囊、安普拉斯（Amplatz）和径向扩张单步肾造瘘术（RESN）系统产生的径向力和轴向力，并报告我们使用新型RESN装置的初步临床结果。球囊、安普拉斯和阿尔肯（Alken）扩张器常用于经皮手术中建立肾造瘘通道。它们需要多个步骤，存在工作导丝扭结和移位的可能性。相比之下，新型RESN通道扩张器可扩张独特的套管导管，并在单一步骤中放置类似安普拉斯的鞘管，在扩张时对导丝的依赖性较小。
设计了一个实验模型，使用带有10F中心开口的穿孔硅盘，在将30F球囊、安普拉斯和RESN系统插入硅盘时测量轴向力传递。我们还报告了首批9例接受RESN系统经皮扩张的患者情况。
对每种测试的扩张器均实现了30F的扩张。与球囊和安普拉斯扩张器相比，RESN装置传递的轴向力明显更低（分别为5.2磅、13.1磅和19.2磅，P<0.001）。术中，所有9例患者均成功扩张，透视成像显示肾脏相对固定。1例曾多次接受肾脏手术的患者在球囊扩张失败后，使用RESN系统成功扩张。
RESN扩张器是一种快速的单步通路系统，已成功应用于我们的首批9例患者。腔内套管扩张消除了维持通路对导丝的依赖，限制了肾脏移位，并为经皮扩张提供了合适的矢量力。
