open nephrostomy

Incision nephrectomy 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. Renal surgery through the lumbar incision requires an understanding of the anatomy of the lumbar fascia and its surroundings. The lower back fascia is divided into two layers, shallow and deep. The shallow layer is thick, covering the shallow surface of the sacral spine muscle. The posterior part is the lower posterior serratus and latissimus dorsi; the deep layer is located in the deep surface of the iliac spine muscle and the lumbar muscle is shallow. The upper part is thickened to form a lumbar ligament ligament, which can increase the activity of the 12th rib after cutting, and is convenient for revealing the kidney. The deep part of the lumbar ligament has a pleural reflex. When the lumbar ligament is cut open on the inside, care should be taken not to injure the pleura. The deep and shallow layers of the lumbar fascia are fused on the lateral side of the iliac spine muscle to form the tendon of the transverse abdominis and the internal oblique muscle. Treatment of diseases: renal pelvis and ureteral junction obstruction hydronephrosis Indication Incisional nephrostomy is applicable to: 1. Hydronephrosis combined with severe infection or empyema. 2. Severe hydronephrosis, renal dysfunction, incision of renal ostomy to improve renal function before radical surgery. 3. Renal pelvis or pelvic ureter junction stenosis after plastic surgery must be drained. 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. Incision surgery generally does not require extensive free kidney, so the skin incision should be short, often taking a oblique oblique incision. Cut the skin and subcutaneous tissue to reveal the latissimus dorsi and the external oblique muscle. 2. The muscles are bluntly separated and retracted to the sides, and the fascia of the lower back and the fascia around the kidney are cut to reveal the kidneys. 3. Select a thinner part of the kidney surface on the kidney surface, puncture the urine, exit the puncture needle, poke the hole along the puncture hole with a straight mosquito pliers, and enlarge the hole. The hole is close but it is better not to exceed the stoma. The diameter of the tube was inserted into the renal pelvis by a 12- to 14-gauge or balloon catheter. It was confirmed that the urethral catheter was circulated smoothly and then sutured with a 3-0 gut in the renal capsule to fix the stoma. You can also do all the mouth in the renal pelvis, insert a long curved vascular clamp, select the appropriate site to poke the renal parenchyma, introduce the catheter into the renal pelvis, and then fix the ostomy tube and suture the pelvis with 3-0 flat gut. incision. 4. Suture the incision, place the stoma tube as far as possible and fix it to the skin with 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.