pyelostomy and nephrostomy

The purpose of renal pelvic fistula is to drain the renal pelvis, improve renal function, reduce renal pelvis and renal parenchymal infection, but postoperative renal pelvis can be repeatedly infected due to ostomy, affecting renal function. Therefore, this operation can only be used as a rescue measure to relieve obstruction. Treatment of diseases: congenital renal pelvis and ureteral junction obstruction in children with chronic pyelonephritis Indication 1. The ureter is obstructed for some reason (such as injury or tuberculosis), and the systemic conditions are not allowed to use other methods to relieve the obstruction. 2. Kidney empyema, systemic conditions are not allowed for nephrectomy, or for other reasons must be preserved. 3. Late bladder cancer, so that the ureter is blocked on both sides. 4. After kidney stone removal. Preoperative preparation 1. Check the vital organs of the body, especially the renal function test (generally including urine routine, blood urea nitrogen determination and phenol red test), to determine whether the Jianbian kidney can compensate for urinary function. 2. Preoperative pyelography must be performed to determine the condition of the two kidneys. At the same time, it should be repeatedly verified where the diseased kidney is. Such as the newly discovered non-functional kidney of venous pyelography, although it can be caused by lesions, but it can also be caused by loss of contrast agent, or temporary renal artery spasm, should be identified. 3. Perform the necessary preoperative treatment. For example: kidney injury combined with shock, must be actively rescued, kidney tuberculosis should be treated before anti-tuberculosis treatment for a period of time (usually 2 weeks), urinary tract infection should be controlled, water and electrolyte disorders should be corrected, anemia and high blood pressure Should try to improve. Surgical procedure 1. Incision: The incision can be slightly shortened through the incision under the 12th costal margin. 2. Intubation drainage: The renal parenchyma is cut in the thinner part of the cortex. The incision should be small, as long as the hemostatic forceps can be inserted into the renal pelvis through a hemostatic forceps. If the renal cortex is thicker, a longitudinal incision can be made in the back of the renal pelvis, and a curved hemostatic forceps is inserted into the kidney. The renal parenchyma is taken out from the posterior side of the kidney and the ureter is clamped into the renal pelvis. Inside. 3. Stitching: suture the renal pelvis and the incision with the intestine, and drain the cigarette outside the fistula.