Thüroff J W, Hutschenreiter G
Urol Int. 1980;35(5):375-80. doi: 10.1159/000280351.
Percutaneous nephrostomy under ultrasonic guidance is a reliable method for suprapublic urinary diversion with a low complication rate. Indications are acute or chronic obstruction of the upper urinary tract from the intravesical ureter to the neck of renal calyx. Etiology of the obstruction may be a renal or ureteral calculus, an intrinsic or extrinsic (radiogenic, inflammatory, tumorous) stenosis of the ureter or a functional ureteral obstruction (megaureter, reflux). In the reported case of an ultrasonically guided percutaneous nephrostomy, the indication for urinary diversion was blocking renal calculus with urosepsis. Any operative procedure was contraindicated because of several internal disease. With sufficient urinary drainage, fever subsided and gradual dilatation of the nephrostomy channel with instrumental extraction of the calculus could be performed under local anesthesia. Percutaneous nephrostomy is recommended for urinary diversion in cases of blocking renal calculi with infection if an operation cannot be performed. This approach bears the option of a later cure by intrumental extraction, litholypaxy or chemical dissolution of the stone.
超声引导下经皮肾造瘘术是一种可靠的耻骨上尿路改道方法，并发症发生率低。其适应证为上尿路自膀胱内输尿管至肾盏颈部的急性或慢性梗阻。梗阻病因可能为肾或输尿管结石、输尿管的内在或外在（放射性、炎性、肿瘤性）狭窄或功能性输尿管梗阻（巨输尿管、反流）。在报道的超声引导下经皮肾造瘘术病例中，尿路改道的指征是伴有尿脓毒症的梗阻性肾结石。由于多种内科疾病，任何手术操作均为禁忌。通过充分的尿液引流，发热消退，在局部麻醉下可进行肾造瘘通道的逐步扩张并通过器械取出结石。对于因感染导致梗阻性肾结石且无法进行手术的病例，推荐采用经皮肾造瘘术进行尿路改道。这种方法为后续通过器械取出、体外冲击波碎石或结石化学溶解实现治愈提供了选择。
