Milanović D, Krstić Z, Perović S, Smoljanić Z, Golubović Z
Acta Chir Iugosl. 1990;37(1):89-100.
During the period from April 1986 to March 1988 on the Pediatric Clinic in Belgrade a total of 12 percutaneous nephrotomies were performed to relieve obstruction of the upper urinary tract. The youngest patient was a two-month old with giant hydronephrosis, and the oldest was a 12-year old girl with an acute kidney obstruction caused by impaction of wedging the poured off stone. The most common reasons for obstruction of the upper urinary tract were congenital stenoses and postoperative scars, urethrocystoneostomia and pyeloplasty. The most frequent clinical manifestations in patients on whom nephrotomy was carried out as an emergency operation were infection, palpable tumor (cyst) and acute kidney insufficiency. Percutaneous nephrostomy was always performed with basal sedation and local infiltrative anesthesia under X-ray control. Surgery was necessary in all cases, but no complications needing surgical intervention occurred. Mild hematuria can be expected at almost every punction, so it should not be treated as a complication. Dislocation of the nephrostoma catheter immediately after surgery can be a complication which necessitates reintervention, but if this happens after more than ten days, the catheter can easily be replaced through the formed fistulous channel. In one case percutaneous placing of the catheter was not possible, so it was placed surgically in the kidney and skin to enable drainage of the infected urinome a month after rupture of the ureteropyelic segment. Percutaneous placing of a catheter through the nephrostoma is the method of choice for urgent and temporary relief of obstructions of the upper urinary system regardless of etiology, and this procedure achieves immediate therapeutic and, if necessary, diagnostic effect which enables recovery of the patient and preparation for definitive surgery which in such a situation could be hazardous.
1986年4月至1988年3月期间，在贝尔格莱德的儿科诊所共进行了12例经皮肾造瘘术，以缓解上尿路梗阻。最年轻的患者是一名两个月大的巨大肾积水患儿，最年长的是一名12岁女孩，因脱落结石嵌顿导致急性肾梗阻。上尿路梗阻的最常见原因是先天性狭窄和术后瘢痕、尿道膀胱造口术和肾盂成形术。作为急诊手术进行肾造瘘术的患者最常见的临床表现是感染、可触及的肿块（囊肿）和急性肾功能不全。经皮肾造瘘术总是在基础镇静和局部浸润麻醉下，在X线控制下进行。所有病例均有必要进行手术，但未发生需要手术干预的并发症。几乎每次穿刺都可能出现轻度血尿，因此不应将其视为并发症。术后立即出现肾造瘘管移位可能是一种需要再次干预的并发症，但如果在十天后发生，可通过形成的瘘道轻松更换导管。有一例无法经皮放置导管，因此通过手术将其放置在肾脏和皮肤之间，以便在输尿管肾盂段破裂一个月后引流感染性尿液。无论病因如何，经肾造瘘口经皮放置导管是紧急和临时缓解上尿路系统梗阻的首选方法，该操作可立即产生治疗效果，如有必要还可产生诊断效果，使患者康复并为可能有风险的确定性手术做好准备。
