経皮性穿刺腎瘻術(Percutaneous Trocar Nephrostomy)について

Abstract

We have reported on a new method used for tempo r a ry urinary drainage of the renal pelvis. TE C HNIC.—The patient is placed on a full length x-ray table or operating table and preliminary x-rays, especially percutaneous direct pyeloureterogram after renal percutaneous needle puncture, are made to localize the approximate spot of renal puncture in relation to the tip of the last rib and axillary line. In the beginning, a 6 in., 19 gauge needle can be punctured into the renal pelvis after local infiltration anesthesia with 1 % procaine. In the next, special trocar we have made as figure 1 for percutaneous renal punctue is introduced along the aforesaid needle. If a mass palpable, the trocar is directed toward it. When the trocar is got to renal pelvis of hydronephrosis, urine is spouted. If there is doubt about position, x-ray control is indicated. After the ren a l pelvis has been entered, No. 7 Nelaton's gummi catheter is introduced more than enough through the trocar into the renal pelvis of hydronephrosis. The trocar is removed and the catheter taped to the skin so that it can not be moved or will not kink. T his trocar nephrostomy was tried in 3 patients of severe hydronephrosis by ureteral stricture after ureteral tuberculosis with renal and vesical tuberculosis and with uremic symptoms. Two patients made good conditions and a patient was died. Possible complications are hemorrhage, infection or anuria. W e did not observe the obstruction and kinking of the Nelaton's gummi catheter. This procedure is urgent and conservative treatme n t, but it can be utilized as permanental treatment.