経皮的腎瘻造設術について --その方法と問題点

Abstract

1)腎後無尿症あるいは水腎症28腎, 尿瘻5腎, 膀胱出血2腎, 経皮的腎尿管切石術(PNL)の術前45腎に対して経皮的腎瘻造設術(NS)を行った.2)超音波ガイド下に経皮的に腎穿刺を行い, 目的とする腎杯に0.038インチ・J型ガイドワイヤーを留置し, マレコー・ネフロストミー・セットの筋膜ダイレーターを用い腎瘻を拡張した.3)水腎症や尿瘻などに対し, Malecot 14 Frあるいは16 Frカテーテルを留置した.PNL術前処理の場合にはMalecot 18 Fr, 24 FrあるいはBardex先穴バルンカテーテル18～22 Frを留置した.4)無尿1例とPNL術前症例1例においてPNSに失敗した.拡張に際してはX線TVによる透視観察が重要である.5) PNS前後で永久的腎瘻群と一時的腎瘻群ではHtはほとんど変化せず, PNL群では数%低下した.6)腎シンチグラム上PNSにより腎実質障害例をみた.7) 37°C以上の発熱をきたしたのは約70%で, うち39°C以上は4腎瘻であった.マレコー・ネフロストミー・セットを用いてのPNSは安全かつ確実な方法である

Ultrasound guided percutaneous nephrostomy (PNS) was performed on 72 patients (80 kidneys) including pretreatment for percutaneous nephro-uretero lithotomy (PNL). PNS was performed for post-renal anuria or hydronephrosis in 23 cases (28 kidneys), for urinary leakage in 4 cases (5 kidneys), for vesical bleeding in 1 case (2 kidneys) and as pretreatment of PNL in 44 cases (45 kidneys). Ultrasound guided renal puncture was done percutaneously and a 0.038 inch J-tipped wire guide was inserted into the suitable calyx. Then the nephrostomy tract was dilated with fascia dilators of Malecot nephrostomy set. A 14 Fr or 16 Fr Malecot catheter was used for hydronephrosis or urinary leakage cases. 18 Fr, 24 Fr Malecot catheter or Bardex balloon catheter 18-22 Fr was inserted for PNL cases. In the PNL group, Ht decreased slightly but there was no need of blood transfusion. In the other groups, Ht did not change. Defect of 99m-Tc-DMSA renal uptake in several cases suggested renal injury at nephrostomied cortex. In about 70% of the cases, a fever of more than 37 degrees C was observed, and in 4 cases, more than 39 degrees C was observed. There were no major complications observed. In conclusion, percutaneous nephrostomy using Malecot nephrostomy set is a safe and effective method.