percutaneous nephroscopy

Percutaneous nephroscopy is an auxiliary diagnostic method for checking whether the kidney is normal. Percutaneous nephrolithotomy is a technique for inspecting, diagnosing and treating the upper urinary tract by expanding the skin-to-kidney system channel formed by expansion. It is one of the most valuable diagnostic measures in the field of urology. Basic Information Specialist classification: urinary examination classification: urine / kidney function test Applicable gender: whether men and women apply fasting: not fasting Tips: Patients with systemic hemorrhagic disease, acute kidney and kidney infection should not be tested. Normal value No abnormalities in the kidneys were found during the examination. It is a dark red substantive organ that looks like broad beans. The kidney surface is smooth and can be divided into upper and lower ends, front and back sides, and inner and outer edges. Clinical significance Abnormal results: 1. Hematuria is the most common complication, usually within 1 to 2 days. If there is severe hematuria, it means that there is active bleeding in the renal parenchyma, and the hemorrhage can be stopped after the ostomy tube with the balloon is pulled. Once there is too much bleeding, a balloon dilator can be used to stop bleeding if necessary. 2. Infection is generally uncommon. If there is a urinary tract infection before the test, it may cause the infection to spread. Patients with urinary tract infection before surgery should be examined after controlling infection, and antibiotics should be used to prevent infection. 3. Post-membrane hematoma or urinary cyst The retroperitoneal hematoma is caused by intravascular renal injury. If the puncture site is on the dorsal side of the kidney, severe retroperitoneal hematoma rarely occurs. Most of them can gradually disappear once they occur. If the hematoma is progressively enlarged, surgical exploration is required. The urinary cyst is caused by poor drainage of the fistula, and it can disappear after adjusting the position of the drainage tube. 4. Peripheral organ damage is mainly caused by improper puncture. This complication can be avoided by puncture under the guidance of a B-ultrasound probe. 5. The imbalance of water and electrolyte balance occurs mostly when the high pressure perfusion time with distilled water is too long. Low pressure perfusion with saline can prevent the occurrence of water poisoning. Diuretics should be used in time to accelerate the water discharge and treat with hypertonic saline. People who need to check: 1. Kidney, upper ureteral stones; 2. Foreign body in the kidney; 3. Diagnosis and differential diagnosis of renal pelvis or renal pelvic space occupying lesions; 4. Examination, biopsy, electrocautery, resection, etc. of renal epithelial tumors; 5. Treatment of renal pelvic and ureteral junction stenosis; 6. Non-reflux, chronic ureteral dilatation, percutaneous nephroscopy to understand the anatomy and function of the upper urinary tract, combined with urodynamic examination to determine treatment. Precautions Love, clear inspection purposes. The patient's preparation is performed according to the kidney operation. In addition to the examination of all important organ functions before surgery, a comprehensive imaging examination of the urinary tract is needed to help the surgeon understand the anatomy of the renal pelvis and renal pelvis and determine the path of percutaneous puncture of the renal pelvis. . Check the blood type before surgery and prepare a certain amount of whole blood. Apply antibiotics before surgery and indwell the catheter. The equipment is prepared to check whether the equipment is complete and the functional status is good. The lavage fluid can be used with physiological saline. Post-examination treatment: 1. Regular nursing of kidney surgery, pay attention to protect the fistula and keep it open. 2. Apply antibiotics to prevent infection. 3. Encourage more drinking water after recovery of intestinal function. Inspection process 1. Position: Generally, the position in the prone position or the prone position is 30 degrees higher than the affected side. 2. Anesthesia: epidural anesthesia or general anesthesia. 3. Operation steps: Percutaneous nephroscopy requires three steps of puncture, dilation, and mirror insertion. (1) Puncture: Accurate puncture into the infrarenal or medial malleolus is the basis of percutaneous renal pelvis operation. The puncture site requires the puncture needle to pass through the renal parenchyma in the posterior and inferior vascular regions of the renal lateral margin, avoiding larger blood vessels. Generally, the intersection of the lower edge of the twelve ribs and the posterior iliac line is selected. Use a sharp knife to cut the skin at the puncture site by 1 to 1.5 cm, and use a vascular clamp to plunge into the fascia. The puncture needle can be used with a needle length of 20 to 25 cm and a needle with a needle core and an outer sheath, which is guided by a B-type ultrasonic puncture probe. This is also the easiest and most accurate method of puncture to the destination. If there is no ultrasound equipment, high-dose venography or retrograde pyelography can be performed under the guidance of X-ray fluorescence imaging. If the hydronephrosis is severe, it can be directly puncture with a thin needle. After the puncture was successful, urine was discharged, and the guide wire (diameter 0.089 to 0.096 cm, length 100 to 145 cm) was immediately inserted. The insertion depth of the guide wire should be 5 to 6 cm beyond the needle. (2) Dilation: After the puncture needle is placed in the guide wire, the puncture needle is removed and the guide wire is retained. Guided by a guide wire, use a thin dilator such as a 5FTeflon dilator to expand, gradually increase the dilator number for expansion, Teflon dilator should be extended to 30F, the sheath can be inspected, and the metal dilator expands to 24F After that, the dilator is taken out, and the nephron sheath is placed outside the 22F dilator and placed in the kidney. After all the dilators are removed, the dilator can be inspected. Dilation of the skin and renal pelvic channels should be carried out under fluoroscopy, paying close attention to the position and shape of the guide wire to prevent the guide wire from coming out and twisting. (3) Inserting and placing the nephroscope: According to the expansion method, the insertion method is slightly different. 1) When using a metal dilator, first put the mirror sheath (as mentioned above), then put it into the sub-mirror. The dilator can also be completely removed, the guide wire is retained, the guide wire is taken out from the obturator channel, the mirror sheath and the obturator are placed in the kidney along the guide wire, the obturator is removed, and the nephroscope is placed. 2) When using the Teflon dilator, the last dilator sheath is retained and the nephroscope is placed along the sheath. (4) Nephroscopy observation: Before the observation of the nephroscope, the focal length should be adjusted. At the beginning of observation, the field of view is mostly red, blurred, and should be flushed with water, sometimes the field of view is blocked by small blood clots, and can be seen after removal. Through the rotation of the mirror body and the advancement and retreat adjustment, the entire appearance of the renal pelvis can be peeped. But be careful not to retreat to the renal parenchyma or the extrarenal. The lesions were performed under the microscope with cystoscopy and ureteroscopy. According to the condition of the disease, take appropriate medical treatment measures. (5) Removal of the nephroscope: The nephroscope can be removed after observation and treatment. If you need to check again in the near future, you should keep the guide wire, otherwise the guide wire will be taken out together. Place the renal fistula along the nephroscope channel and keep the fistula for about one week. Not suitable for the crowd Inappropriate population: 1. Systemic bleeding disorders; 2. Acute infection of kidney and kidney. Adverse reactions and risks No related complications or hazards.