Okada S, Ohara H, Tonami H, Hasegawa F, Inoue H, Kanbara A, Takasaki N, Miyazaki S
Department of Urology, Osaka Medical School.
Hinyokika Kiyo. 1988 Apr;34(4):613-8.
Between June, 1985 and November, 1986, 25 patients at our institute underwent retrograde nephrostomy placement to provide percutaneous access to the kidney for percutaneous nephrolithotomy (PNL) of renal or upper ureteral calculi. Overall, retrograde nephrostomy was successfully completed through the desired calyx in 80% of the patients and calculi were successfully removed by the subsequent PNL. There were 5 failures primarily due to wrong indication and inexperience with the technique. The procedures had been done without significant complications in this series including unsuccessful cases. On the basis of our experiences, it is practically important for successful retrograde nephrostomy to fix the tip of the catheter firmly in the desired calyx until the puncture wire is advanced into the renal parenchyma. It is also important to aim the puncture wire at the skin in a favorable direction to avoid adjacent visceral penetration. Retrograde nephrostomy is a useful aid for percutaneous calculus removal particularly in patients with nondilated intrarenal collecting systems, because this new technique allows precise tract placement to the kidney required for efficient calculus manipulation with less risk than that associated with conventional percutaneous nephrostomy.
1985年6月至1986年11月期间，我院25例患者接受了逆行肾造瘘术，以便为经皮肾镜取石术（PNL）治疗肾或输尿管上段结石提供经皮进入肾脏的通道。总体而言，80%的患者通过所需的肾盏成功完成了逆行肾造瘘术，随后的经皮肾镜取石术成功取出了结石。有5例失败主要是由于适应症错误和技术不熟练。在本系列中，包括未成功的病例，手术均未出现重大并发症。根据我们的经验，对于成功的逆行肾造瘘术来说，在穿刺导丝进入肾实质之前，将导管尖端牢固地固定在所需的肾盏中至关重要。将穿刺导丝朝着有利的方向对准皮肤以避免穿透相邻内脏也很重要。逆行肾造瘘术是经皮取石的一种有用辅助方法，特别是对于肾内集合系统未扩张的患者，因为这种新技术允许精确地将通道放置到肾脏，以便有效地操作结石，且风险低于传统经皮肾造瘘术。
