Versiegelungstechniken bei der perkutanen Nephrolitholapaxie

 

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Zusammenfassung

Seit der Einführung der perkutanen Nephrolitholapaxie (PCNL) hat sowohl das Instrumentarium als auch die Operationstechnik einen innovativen Wandel erfahren. Die Miniaturisierung der Instrumente hat sowohl zu einer Verkürzung des Krankenhausaufenthalts, geringeren Transfusionsraten als auch Erweiterung der Indikationsstellung geführt. Routinemäßig wurde klassischerweise postinterventionell eine Nephrostomie zur Hämostase und Vermeidung einer Urinombildung eingelegt. Schon 1997 wurde erstmals die Notwendigkeit der Nephrostomie in Frage gestellt, und in einer prospektiven Studie mit 50 Patienten die nephrostomielose PCNL untersucht. Seither wurde zunehmend auf die Einlage einer Nephrostomie nach PNL verzichtet. Um Blutungen zu vermeiden kommen dabei ersatzweise verschiedene Hämostyptika zur Versiegelung des Zugangs zum Einsatz, deren Notwendigkeit jedoch noch nicht durch Studien belegt ist. In dieser Übersicht soll der Trend hin zur nephrostomielosen PCNL nachvollzogen werden und verschiedene Methoden zur Traktversiegelung gegenübergestellt werden.

Abstract

Since the introduction of the percutanous nephrolitholapaxy (PNL), the instruments as well as the technique have experienced a tremendous modification. The miniaturisation of the instruments has led to a decreased hospital stay, reduced analgetic use as well as an extension of the indication for PNL. A nephrostomy tube was normally inserted to prevent urinoma and to provoke renal haemostasis. In 1997, the necessity for the regular use of a nephrostomy tube was first questioned. In a prospective study, the nephrostomy tube was successfully omitted in 50 selected patients. Since then, increasingly, the nephrostomy tube is omitted. Alternatively, different haemostatic substances are used for renal tract closure. The necessity for the use of these agents is still unclear.

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