Saltzman B, Khasidy L R, Smith A D
Department of Surgery, Long Island, Jewish Medical Center, New Hyde Park, New York.
Urology. 1987 Nov;30(5):472-4. doi: 10.1016/0090-4295(87)90384-0.
Twenty-five kidneys underwent nephrostomy puncture with placement of a pigtail catheter into an upper pole calyx for manometric recording during nephroscopy without a working sheath and with an Amplatz sheath with and without a Rutner adapter. Intrarenal pressures remained below 16 cm of water (H2O) at all times with the Amplatz sheath with or without a Rutner adapter, whereas without a sheath the pressures ranged from 15 to 31 cm H2O (i.e., pressures associated with significant pyelovenous and pyelosinus backflow). Similar results were obtained in monitoring intrarenal pressures during clinical procedures. A working sheath should be utilized for all percutaneous nephroscopic procedures to minimize the incidence of pyelovenous and pyelosinus backflow as well as of perirenal extravasation of the irrigation solution. Even with a wide-lumen ureteral catheter in place, drainage via the ureter is not sufficient to maintain the intrapelvic pressure in the physiologic range.
25个肾脏接受了肾造瘘穿刺，在无工作鞘、有或无Rutner适配器的Amplatz鞘的情况下，将猪尾导管置入上极肾盏以在肾镜检查期间进行压力测量记录。使用有或无Rutner适配器的Amplatz鞘时，肾内压力始终保持在16厘米水柱（H2O）以下，而在无鞘的情况下，压力范围为15至31厘米H2O（即与显著肾盂静脉和肾盂窦逆流相关的压力）。在临床操作期间监测肾内压力时也获得了类似结果。所有经皮肾镜手术均应使用工作鞘，以尽量减少肾盂静脉和肾盂窦逆流以及冲洗液肾周外渗的发生率。即使放置了宽腔输尿管导管，通过输尿管引流也不足以将肾盂内压力维持在生理范围内。
