NEPHROSTOMY

From Big Medical Encyclopedia

NEPHROSTOMY (nephrostomia; Greek nephros kidney + stoma of companies, opening, pass; synonym nephropyelostomy) — the operative measure consisting in imposing of fistula on a kidney (nefrostom). Operation H. is applied to assignment from a kidney of urine, pus and clots at a pyonephrosis, acute purulent pyelonephritis — its such forms as apostematous nephrite and an anthrax of a kidney; at the excretory anury or a considerable staz of urine caused by a tumor of retroperitoneal space, the bodies of a small pelvis squeezing ureters or regroperitonealny fibrosis; at a rupture of a kidney and damage of an ureter. Resort to N. after interventions on a pelvis and an ureter, at this N. it is more preferable pyelostomies (see).

The temporary nefrostoma is imposed at the infected hydronephrosis, an ureterohydronephrosis, after removal of korallovidny stones for the prevention of postoperative complications and an early recurrence of concrements. The constant to nefrosty is used at impossibility to recover a passage of urine.

It is contraindicated N sick in an end-stage hron, a renal failure.

the Diagrammatic representation of some options of a nephrostomy (the dotted line designated borders of a renal pelvis): and — a nefrostomichesky drainage through a tube of a trocar (1 — a nefrostoma, 2 — the drainage tube which is carried out to a pelvis, 3 — a tube of a trocar); — a chrezlokhanochny nephrostomy Fedorov's clip (1 — a clip, 2 — a section in a back wall of a pelvis, 3 — a nefrostoma, 4 — a drainage tube); in — a chrezlokhanochny nephrostomy the metal conductor (1 — a drainage tube, 2 — a section in a wall of a pelvis, 3 - a nefrostoma, 4 — the metal conductor); — a nephrostomy a trocar under control of a finger at a big pelvis (1 — a section in a wall of a pelvis, 2 — a nefrostoma, 3 — a trocar).

Preparation to the emergency N. is defined by the general condition of the patient. At a rupture of a kidney and an excretory anury with the phenomena of uraemia preoperative therapy shall be intensive and short. Anesthesia is the general, endotracheal with a neyroleptanalgeziya. At big, well palpated N.'s kidney it is possible to execute under local anesthesia. From perinephric cellulose allocate the lower pole of a kidney. Over the scalpel thinned by the site of a parenchyma cut the fibrous capsule or make nephrotomy (see) throughout 8 — 10 mm. Puncture with the Tsistostomichesky trocar a parenchyma to feeling of fall. Delete a stylet from a trocar and through a tube enter a drainage tube into a pelvis (intrapelvic N.) to dia. 5 — 7 mm with 1 — 2 side openings (fig., a). The pelvis is exempted from contents and washed out. The tube from a kidney is deleted. The drainage is fixed to the fibrous capsule. The second tube drain retroperitoneal space. At constant N. the lower pole of a kidney is fixed to muscles of an abdominal wall that facilitates the subsequent shift of drainages.

At korallovidny stones for N. it is possible to use cuts of a renal parenchyma, through to-rye stones were removed from cups.

Chrezlokhanochny N. is applied at a gidroureteronefroza, korallovidny stones, a small and intra renal pelvis, at to-rykh the correct establishment of drainages difficult. At chrezlokhanoch-ache N. make a tunnel in a parenchyma of a kidney Fedorov's clip or the metal conductor from a pelvis (fig., and c), and stretch drainages in a kidney both from a parenchyma, and from a pelvis. It is convenient to carry out a drainage to a kidney by a trocar under control of the finger entered into a pelvis (fig., d). Apply N. with two drainages established at the different levels for inflow and outflow of litolitichesky solution to a litoliz.

Sometimes make circular N., at a cut drain a kidney at the same time through top and bottom cups or through an upper cup and a pelvis; the ends of a tube remove outside.

The constant nefrostomichesky drainage is changed 1 — 2 time a month. Change of drainages is facilitated at circular by N. At temporary N. the drainage from a kidney is deleted in 2 — 3 weeks after recovery of passability of upper uric ways and improvement of function of kidneys.

Complications: bleeding, formation of stones, infection, uric flow and it is long not healing fistulas, obstruction of a drainage tube.



Bibliography: Weinberg 3. C. Stones of kidneys, page 170, M., 1971; Javad 3 and d e M. D. Stones of ureters, page 149, M., 1961; Zhukova M. N., Klyucharev B. V. and Christmas V. I. Surgical diseases of kidneys and ureters, page 411, D., 1965; The Guide to clinical urology, under the editorship of A. Ya. Pytel, page 477, M., 1969; Hienzsch E. Operationen an der Nieren, S. 68, Lpz., 1972.


V. S. Karpenko.

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