What Is a Nephrostomy?

Open nephrostomy is an operation for the surgical treatment of kidney disease.

Open nephrostomy

Right!

Open nephrostomy is an operation for the surgical treatment of kidney disease.

Chinese name

Open nephrostomy

Alias

Incision nephrostomy

Open nephrostomy

Incision nephrostomy

Pediatric Surgery / Kidney Disease Surgery / Nephrostomy

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The kidneys are located on both sides of the lumbar spine, behind the peritoneum of the posterior abdominal wall, and are closely attached to the posterior abdominal wall. Due to the influence of the right lobe of the liver, the right kidney is about 1 to 2 cm lower than the left kidney. The location of the kidney can vary depending on body type, gender, and age. The younger the child, the lower the location, and the lower pole of the newborn kidney can reach the level of ridges.

The upper posterior portion of the kidney is adjacent to the diaphragm, and is adjacent to the costal sinus and the 11th and 12th ribs by the diaphragm and the pleural cavity. When performing kidney surgery, care should be taken to avoid pneumothorax damage to the pleura. Adrenal glands are covered at the upper ends of both kidneys. The front of the kidney is different from left to right. The upper part of the right kidney is attached to the right lobe of the liver, the lower part is adjacent to the right bowel of the colon, and the medial edge is adjacent to the descending part of the duodenum. The right renal vein is short and the inside of the right kidney is adjacent to the inferior vena cava. Care should be taken to avoid injury to the inferior vena cava and duodenum during right kidney surgery. The upper part of the left kidney is adjacent to the fundus of the stomach and the spleen, the pancreas tail traverses in front of the middle, and the lower part is adjacent to the jejunum and left bowel of the colon.

For kidney surgery through a lumbar incision, the anatomical relationship of the back fascia and its surroundings must be understood. The lower back fascia is divided into two layers, shallow and deep. The shallow layer is thicker and covers the shallow surface of the sacrospinalis muscle, and the rear is the lower posterior serratus and latissimus dorsi muscle. The upper part is thickened to form the lumbar costa ligament. After cutting, the 12th rib can be increased in mobility, which is convenient for revealing the kidneys. The deep part of the lumbocostal ligament has a pleural reflex. Care must be taken not to hurt the pleura when cutting the lumbocostal ligament on the inside. Deep and superficial fascia

Open nephrostomy is suitable for:

1. Hydronephrosis with severe infection or pus.

2. Severe hydronephrosis and poor renal function, those who must undergo open nephrostomy to improve renal function before radical surgery.

3. The renal pelvis or pelvic ureteral junction must be drained after plastic surgery.

4. Ureteral obstruction or occlusion caused by trauma, inflammation, tumor or stone, nephrostomy can be used to temporarily relieve pelvic tension.

Children with nephrostomy often have symptoms of poisoning or uremia before surgery. Although nephrostomy can improve these symptoms, attention must be paid to correct electrolyte imbalance and control urinary tract infection before or after surgery.

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The sick child is placed in a lateral position with the affected side at the waist. Anesthesia is mostly continuous epidural block or general anesthesia.

1. Incision surgery generally does not require extensive free kidney, so the skin incision should be short, often oblique waist incision. Cut the skin and subcutaneous tissue to expose the latissimus dorsi and external oblique muscles.

2. Separate the muscles bluntly, and pull them to both sides. Cut the fascia of the back and the fascia around the kidney to expose the kidneys.

3. Select a thinner renal parenchyma on the surface of the kidney, withdraw the puncture needle after puncturing the urine, pierce the hole along the puncture hole with straight mosquito forceps, 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 with a mushroom-shaped or balloon-shaped catheter of No. 12 to No. 14. After confirming that the urinary canal was drained smoothly, a 3-0 intestine was used to perform a purse suture on the renal capsule to fix the stoma tube. You can also make all mouths in the renal pelvis, insert a long-curved vascular forceps, choose the appropriate part to poke through the renal parenchyma, introduce the urethral catheter into the renal pelvis, and then fix the stoma tube and close the renal pelvis with 3-0 flat intestinal sutures. incision.

4. Suture the incision, place the stoma tube as far forward as possible and fix it to the skin with silk thread.

When performing a nephrostomy, if the renal parenchyma is very thick, it is often difficult to find an appropriate way to enter the renal pelvis. Blindly piercing the renal parenchyma may damage large renal blood vessels and cause major bleeding. At this time, it is appropriate to choose a small incision of the renal pelvis. The method of pulling long-neck forceps through the pelvis and kidney into the nephrostomy tube can also be switched to pyelostomy or ureterostomy through the upper ureter.

After open nephrostomy, do the following:

1. Keep the nephrostomy tube draining smoothly. The drainage device should be kept sterile and replaced regularly.

2. Generally, the renal pelvis is not flushed. If there is bleeding, clot clogging or renal pelvis infection, and purulent strip deposits affect drainage, the renal pelvis can be flushed with 1: 5000 furacicillin or saline, but pay attention to low pressure.

3. For children who need to leave the stoma tube for a long time, the time for the first replacement of the stoma tube is 3 to 4 weeks after surgery, and the stoma tube is replaced every 2 to 3 weeks thereafter. When replacing the stoma tube in the first few times, it is better to prepare another sterile stoma tube, and then put the prepared stoma tube immediately after pulling out the original tube to avoid being unable to insert due to the change of fistula path.

1. Leakage around the self-made stoma tube

Often caused by poor drainage after the stoma tube is blocked, the stoma tube should be rinsed or replaced in time with an antibiotic solution.

Hematuria

Often caused by ostomy tube damage to the superficial vessels of the renal pelvis. Sick children should reduce their activities, and appropriate application of hemostatic drugs, infusion and diuresis to prevent blood clots from forming and blocking the stoma tube.