Saad Wael E A, Virdee Sanjiv, Davies Mark G, Patel Nikhil C, Sahler Lawrence G, Lee David E, Kitanosono Takashi, Sasson Talia, Wilson Ian J, Waldman David L
Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York 14642, USA.
J Vasc Interv Radiol. 2006 Sep;17(9):1457-64. doi: 10.1097/01-RVI.0000235703.68819.8C.
To evaluate the incidence and consequences of complete inadvertent percutaneous nephrostomy catheter discontinuation in native kidneys of adults. In addition, this study evaluated the success rate of nephrostomy tract recannulation.
Retrospective analysis was performed in adult patients who underwent percutaneous nephrostomy between January 2000 and December 2005. Patients' conditions were evaluated for complete inadvertent discontinuation of use of the nephrostomy catheters and success of subsequent recannulation procedures. Habitual discontinuation was defined by three catheter discontinuation episodes in one patient. Conditions of patients with inadvertent discontinuation were assessed for major complications before and after the recannulation, including the need for de novo nephrostomy to reestablish clinically needed access. The incidences of inadvertent discontinuation and primary assisted recannulation tract maintenance were calculated according to the Kaplan-Meier method. Successful versus unsuccessful recannulation procedures were compared for tract age, length of time the drain was out of the tract, and catheter diameter with use of the Mann-Whitney U test.
A total of 283 patients underwent 325 percutaneous nephrostomies. The inadvertent catheter discontinuation rates at 6, 12, 24, and 36 months were 26%, 36%, 53%, and 62%, respectively. For the same time intervals, the primary recannulation assisted tract maintenance rates were 94%, 86%, 77%, and 72%, respectively. Habitual discontinuation was seen in 3.2% of the total population and 19.1% of discontinuation cases. The technical success rates of all and first-time recannulations were 85% and 74%, respectively. Tract maturity was the only variable that was statistically significant between successful and unsuccessful recannulations (P < .0001). A total of 3.5% of patients required new nephrostomies.
Despite the high incidence of inadvertent discontinuation of nephrostomy catheters, the major complication rate was only 3.5%, indicating the efficacy of tract recannulation, especially in mature tracts.
评估成人自体肾完全意外拔除经皮肾造瘘导管的发生率及后果。此外，本研究评估了肾造瘘通道再通的成功率。
对2000年1月至2005年12月期间接受经皮肾造瘘术的成年患者进行回顾性分析。评估患者肾造瘘导管完全意外停用情况及后续再通手术的成功率。习惯性停用定义为一名患者出现三次导管停用事件。评估意外停用患者在再通前后的主要并发症情况，包括是否需要重新进行肾造瘘以重建临床所需通路。根据Kaplan-Meier方法计算意外停用和初次辅助再通通道维持的发生率。使用Mann-Whitney U检验比较成功与失败再通手术在通道使用时间、引流管拔出通道的时间长度以及导管直径方面的差异。
共有283例患者接受了325次经皮肾造瘘术。6个月、12个月、24个月和36个月时的意外导管停用率分别为26%、36%、53%和62%。在相同时间间隔内，初次再通辅助通道维持率分别为94%、86%、77%和72%。习惯性停用见于3.2%的总人群和19.1%的停用病例。所有再通及首次再通的技术成功率分别为85%和74%。通道成熟度是成功与失败再通之间唯一具有统计学意义的变量（P < .0001）。共有3.5%的患者需要重新进行肾造瘘。
尽管肾造瘘导管意外停用的发生率较高，但主要并发症率仅为3.5%，表明通道再通有效，尤其是在成熟通道中。
