percutaneous nephrostomy

Renal ostomy is a method of high-grade urinary diversion, which has important applications in urology. Renal ostomy itself is a separate procedure and is sometimes used after other kidney procedures such as pyeloplasty. Renal ostomy is an urgent measure during empyema. At present, due to the development of urological endoscopic techniques, nephrostomy is developed by resolving renal pelvic drainage to percutaneous nephrostomy, taking stones, and draining through the renal stoma, which can be used for angiography in the treatment of extracorporeal shock wave lithotripsy. The location of the stone, and the indwelling nephrostomy tube can make the broken stone easy to be excreted after ESWL treatment, avoiding the stone to block the ureter, and can be treated with percutaneous nephrostomy, which becomes an auxiliary means in the treatment of stones. Curing disease: Indication Percutaneous nephrolithotomy is suitable for: 1. Isolated kidney has obstructive lesions, and urinary occlusion occurs. 2. Severe hydronephrosis, renal dysfunction, can not tolerate complicated surgical treatment. 3. Severe renal empyema, drainage of renal pus, is conducive to improving the symptoms of patient poisoning, and is conducive to follow-up treatment. 4. Renal or ureteral disease surgery, as a temporary urinary flow steering, is conducive to wound healing. 5. When the obstructive disease (malignant tumor) of the bilateral ureter or the bladder is unable to cure. 6. Some kidney cast stones are treated with percutaneous nephrostomy and ESWL. Contraindications The contraindications for nephrostomy are less, and should be cautious for those with coagulopathy and bleeding. Preoperative preparation 1. For critically ill patients, measures should be taken to improve the overall condition of the patient, such as correcting anemia, treating sepsis, uremia, correcting water, electrolytes, acid-base balance disorders, etc. This is important for emergency kidney ostomy. 2. Select a suitable ostomy method based on the condition of the lesion and the patient's systemic tolerance. If the renal pelvis is separated <3cm, percutaneous nephrectomy is more difficult, and it is better to use orthotopic nephrostomy or free nephrostomy. 3. Apply antibiotics to prevent and treat infections. Surgical procedure 1. Select the puncture point The puncture point is the intersection of the 12th costal margin and the posterior tibial line on the affected side. The puncture point is generally determined by B-ultrasound and marked. Determining the puncture point with B-ultrasound can also help to find out the distance from the puncture site to the renal parenchyma and the thickness After local anesthesia, use a long needle to puncture at this point. After taking out the urine, make a small incision in the skin of the needle. Cut the skin and subcutaneous tissue 1 to 2 cm and pull out the long needle. 2. Puncture stoma Use a trocar to puncture the kidney along the direction of the long needle. When the trocar passes through the renal parenchyma, there is a sudden loss of resistance. Then push the trocar forward 0.5~1cm, pull out the needle, see urine. The fluid flows out, and the appropriate depth of the drainage tube is prepared to insert the appropriate depth of the renal pelvis from the cannula lumen, and the drainage tube is confirmed in the renal pelvis. After the depth is adjusted to the flow, the trocar is pulled out, the skin incision is sutured, and the skin is properly fixed. Drainage tube. 3. You can also use the Seldinger percutaneous intubation technique to make a renal puncture stoma. The method is to select the puncture point according to the same method as the renal puncture ostomy, and puncture the skin with a knife tip under local anesthesia, the puncture needle is thereby pierced, directly reaches the renal pelvis, and the needle core is pulled out, and after the urine is extracted, the guide wire is taken. Insert the renal pelvis from the lumen of the needle, then pull out the puncture needle, leave the guide wire, expand the fistula with a special dilator, use the appropriate catheter as the drainage tube, put the catheter on the guide wire, and follow the guide wire. After the skin is inserted into the renal pelvis, it is determined that the ostomy tube enters the renal pelvis (the ostomy tube has urine flowing out, indicating that the ostomy tube has been inserted enough depth), the guide wire is pulled out, and the ostomy tube is drained. If the urine that is drained contains more blood or the drainage material is thicker, it may block the ostomy tube. Repeat the irrigation with isotonic saline until the liquid is turned off, no blood clots and pus. During the rinsing process, according to the drainage situation, the depth of the ostomy tube is adjusted to prevent the ostomy tube from being placed in a certain renal pelvis, which makes the postoperative drainage difficult and affects the therapeutic effect. After the position of the stoma tube is appropriate, the skin is sutured and the stoma tube is fixed. complication 1. Bleeding. 2. The stoma tube is prolapsed. 3. Stone formation. 4. Extravasation of urine and formation of urinary fistula.