tailieunhanh - Manual Endourology - part 9

thận sẽ được giới thiệu và hệ thống thu thập được kiểm tra. ▬ guidewire ban đầu là loại bỏ và hệ thống lithotripsy được giới thiệu. ▬ Thường xuyên tưới nước cho hệ thống thu thập với chất lỏng thủy lợi đẳng trương để đảm bảo khả năng hiển thị tối ưu. ▬ lithotripter siêu âm | 96 Chapter 11 Percutaneous Nephrolithotomy and Percutaneous Nephrostomy Finally the sheath of the nephroscope is advanced into the renal pelvis. Be aware of risk of perforation since there is no resistance to the advancing nephroscope. Part III Management of the Stone The nephroscope is introduced and the collecting system is inspected. The initial guidewire is removed and the lithotripsy system is introduced. Constantly irrigate the collecting system with isotonic irrigation fluid to ensure optimal visibility. Ultrasonic lithotripter is recommended with advantages of continuous suction effect allowing a clear view and minimizing dislodge-ment of fragments. Alternatively laser smaller stones can be used stone fragments must be removed with a stone grasper. Tip with large fragments remove the fixed stone together with the nephroscope through the sheath. Make sure that the sheath stays in place while removing fragments to avoid loss of working tract and or dislocation of the stone into the working tract. Avoid excessive leverage of the rigid nephro-scope to prevent rupture of the collecting system or haemorrhage. Once lithotripsy is completed the guidewire is reinserted into the renal pelvis. The collecting system is thoroughly inspected for stone fragments. This particularly must include inspection of the UPJ and the junction of the working tract and lower calyx. The guidewire ensures safe reinsertion of the sheath and nephroscope if continuity with the calyx is lost. Place the nephroscope in the lower calyx and perform pyelography to exclude residual stone fragments and inadvertent rupture of the PCS. The nephroscope is removed and a 20-Fr balloon nephrostomy is placed via guidewire into the renal pelvis. Under X-ray guidance the balloon is filled 2 ml and placed into the renal pelvis or upper calyx. Secure the nephrostomy with a ligature at skin level. Rotate the patient to the supine position and remove the ureteral catheter. Leave the Foley catheter to identify