What Is a Nephrolithotomy?

There are two types of kidney injury: open and closed. Open injuries account for about 15% to 20% and are more common in wartime. Closed injuries are most common in traffic accidents and work-related injuries. Renal injury can be accompanied by trauma to the thoracoabdominal organs and other parts, especially open injuries. Attention should also be paid to the diagnosis and treatment of combined injuries.

Basic Information

Chinese name

Nephrectomy

Visiting department

Urology

Anesthesia and preoperative preparation for nephrectomy

Anesthesia mode

Epidural or general anesthesia.

2. Preoperative preparation

1. Renal injury patients who need nephrectomy, most of which are more severe, and often accompanied by shock and major bleeding or combined injuries. Anti-shock treatment should be active. Operate after the injury is slightly stable.

2. Prepared for blood supply.

3. In case of injury, intravenous urography or B-ultrasound and CT examination should be performed before operation to understand bilateral kidney morphology and function.

4. Indwelling the catheter.

Indications for nephrectomy

1. Severe fragmentation of the kidney, especially penetrating firearm injury, and heavy bleeding that cannot be controlled.

2. Severe renal pedicle injury or renal vascular rupture cannot be repaired or reconstructed.

3. Renal blood vessels have extensive thrombosis after renal injury, and renal blood circulation is severely impaired.

4. Renal pelvis tear or broken ureter can not be repaired or anastomosis.

5. Infection, necrosis and secondary major bleeding after kidney injury.

6. Late complications of kidney injury, such as pyelonic ureteral stenosis and hydronephrosis complicated by refractory pyelonephritis, pus kidney, persistent sputum, paralyzed kidney, atrophic kidney with renal hypertension or renal nonfunction, combined with kidney Those who cannot retain kidney stones.

Nephrectomy procedure

The general steps of surgery: explore and control bleeding. exposed kidney. exposed renal pedicle blood vessels. Ligation of renal arteries and veins. Cut off the ureter and remove the kidney. Close the incision and place rubber drainage strips on the kidney bed.

Postoperative nephrectomy complications

Postoperative secondary bleeding and infection.

Nursing after nephrectomy

After general anesthesia, routine nursing, wound cleaning, drainage tube unblocking, health education, can be taken on the affected side 6 hours after operation to reduce abdominal distension, and 24-48 hours after operation to encourage getting out of bed.

Nephrectomy considerations

1. Pay close attention to the whole body and pay attention to water and electrolyte balance.

2. Record the input and output. Those with low urine volume should pay attention to finding the cause. If the shock has been corrected and the blood volume has been made up and the urine volume is still small, mannitol or other diuretics should be used.

3. Patients undergoing abdominal surgery should generally be placed in the gastrointestinal decompression, fasting until the gastrointestinal motility is restored, before removing the gastric tube.

4. Use antibiotics to prevent infection.

5. Wound drainage was removed 48 to 72 hours after surgery.

Diet after nephrectomy

Fasting and drinking before anal exhaust, liquid diet 1 day after exhaust, semi-liquid diet 2-3 days after exhaust-general food. Drink plenty of water and avoid spicy food.