Nephrostomy

Renal puncture ostomy is used for the surgical treatment of kidney disease. The kidneys are located on both sides of the lumbar spine, behind the peritoneum of the posterior wall of the abdomen, and close to the posterior wall of the abdomen. The right kidney is about 1 to 2 cm lower than the left kidney due to the influence of the right lobe of the liver. The location of the kidney can vary depending on size, gender and age. The younger the age, the lower the position, and the lower pole of the neonatal kidney can reach the level of sputum. The posterior upper part of the kidney is adjacent to the diaphragm and is adjacent to the rib sinus and the 11th and 12th ribs of the diaphragm and pleural cavity. When performing kidney surgery, care should be taken to avoid damage to the pleura and cause pneumothorax. Both upper kidneys have adrenal coverage. The front of the kidney is different from left to right, the right upper part of the right kidney is attached to the right lobe of the liver, and the lower part is adjacent to the right curvature of the colon. The medial edge is adjacent to the descending part of the duodenum, and there is no peritoneal septum. The right renal vein is short, and the right kidney is adjacent to the inferior vena cava. Care should be taken to avoid damage to the inferior vena cava and duodenum during surgery on the right kidney. The upper part of the left kidney is adjacent to the fundus and spleen, the front of the middle part has a pancreatic tail crossing, and the lower part is adjacent to the jejunum and colon left curvature. Treatment of diseases: renal insufficiency, hydronephrosis Indication Renal puncture ostomy is suitable for: 1. Hydronephrosis combined with severe infection or empyema. 2. Severe hydronephrosis, renal dysfunction, renal sputum drainage before renal surgery to improve renal function. 3. Renal pelvis or renal pelvis ureter junction stenosis after temporary plastic surgery. 4. Ureteral obstruction or occlusion caused by trauma, inflammation, tumor or stone, renal stoma can be used to temporarily relieve renal pelvic tension. Preoperative preparation Patients who need a nephrostomy often have symptoms of poisoning or uremia before surgery. Although the renal stoma can improve these symptoms, it is necessary to pay attention to correcting electrolyte imbalance and controlling urinary tract infection before or after surgery. Surgical procedure 1. If conditions permit, it can be carried out under the guidance of B-ultrasound. The sick child is placed in the lateral position, the affected side is on the upper side, and the base is added with local anesthesia. The kidney is puncture with the slender needle at the rib angle. After pumping the urine, Make a small skin incision at the needle and pull out the needle. 2. Using a trocar to puncture the kidney according to the direction and depth of the slender needle, and withdraw the needle core. If there is urine flowing out, remove the needle core, insert the catheter with the corresponding diameter into the renal pelvis, and withdraw the trocar sheath. The catheter is fixed to the skin with a silk thread. complication 1. Leakage around the self-made mouth tube Often due to poor drainage after ostomy tube occlusion, should promptly rinse or replace the ostomy tube with antibiotic solution. 2. Hematuria Often caused by the ostomy tube damage to the superficial blood vessels of the renal pelvis. The sick child should reduce the activity, appropriate application of hemostatic drugs, infusion and diuresis to prevent blood clots from forming and plugging the stoma.