经皮穿刺肾盂造瘘术临床应用的探讨

目的探讨x线或cT引导下经皮肾盂造瘘percutaneous nephrostomy，PCN）在临床中的应用价值及安全性。方法65例患者（85个患肾），其中由于肿瘤侵犯或压迫输尿管引起肾盂积水需要引流的病例40例，泌尿系结石需要行经皮肾穿刺造瘘延期输尿管镜下碎石取石（pcrcutaneous nephrostolithotomy,PCNL）的病例25例。所有患者在x线或cT引导下穿刺，采用seldinger法将导管放置于扩张的肾盂输尿管内，引流减压或建立通道。结果一次穿刺成功率95％，经过调整后穿刺成功率100％。置管后行引流减压的病例肾功能明显改善，碎石的患者通过PCN通道顺利行输尿管镜下取石。所有患者无严重并发症发生。结论x线或CT引导下经皮肾造瘘安全、有效，并发症少，对改善肾后梗阻引起的肾功能衰竭具有非常重要的临床意义，同时能为泌尿外科输尿管镜下取石建立良好的通道。

Clinical application of percutaneous nephrostomy

Objective To investigate the clinical value and safety of percutaneous nephrostomy（PCN） in patients with obstruction of renal uremia. Methods X-ray or CT-guided PCN by using Seldinger＂ s technique was performed in 65 patients （85 kidneys）, among of them, 40 patients had hydronephrosis because of invading or oppression of tumors, and 25 patients with calcul would undergo pcrcutaneous nephrostolithotomy （PCNL）. Results The success rate of puncture was 95% at first attempt and 100% after regulate of puncture needle. The improvement of renal function was marked in the patients with hydronephrosis after drainage and PCNL was finished successfully in the patients with calcul. No severe complications occurred. Conclusion PCN is a safe and effective procedure for patients with obstructive uropathy and has important role in improving of renal functiong and building access for PCNL.