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我院自1986年以来,对13例小儿肾积水进行了经皮穿刺肾造瘘术(PCN),现将护理报告如下。一般资料 本组13例,男10例,女3例,年龄6月～13岁,平均5.9岁。双侧肾积水3例,左侧8例,右侧2例。腹部均可触及囊性包块,大小为8cm×4cm～15cm×10cm。B超检查腹部包块为无回声液性暗区,与肾脏相连。9例肾实质变薄,4例未显示肾实质声像。11例行排泄性尿路造影,8例不显影,3例延迟;90～120分钟摄片,2例显淡影,1例不显影。临床诊断:中度肾积水5例,重度肾积水8例。方法 在局麻或氯胺酮分离麻醉,B超或X线监护下进行,取俯卧位,患侧抬高30°,于第12肋缘下骶棘肌外侧缘作0.5cm皮肤切口,垂直置入6—7号心内注射针,达肾脂肪囊后随呼吸摆动,有落空感即进入肾内,可抽吸出尿液。拔除后按试穿针的深度及方向更换腹腔穿刺放液针,进入同样深度后取出针蕊,尿液溢出,迅速从针鞘内插入F8—12号硅胶导尿管,引流通畅后用4号丝线缝合皮肤并固定造瘘管。
Since 1986, our hospital for 13 cases of hydronephrosis in children were percutaneous nephrostomy (PCN), the nursing report is as follows. General information The group of 13 patients, 10 males and 3 females, aged 6 months to 13 years, mean 5.9 years. Three cases of bilateral hydronephrosis, left in 8 cases, right in 2 cases. Abdominal access to cystic mass, the size of 8cm × 4cm ~ 15cm × 10cm. B ultrasound examination of abdominal mass anechoic anechoic area, connected with the kidney. 9 cases of thinning of the renal parenchyma, 4 cases did not show the renal psychedelic. 11 cases of excretory urography, 8 cases did not develop, 3 cases delayed; 90 ~ 120 minutes radiography, 2 cases were light, 1 case of no imaging. Clinical diagnosis: 5 cases of moderate hydronephrosis, severe hydronephrosis in 8 cases. Methods: Anesthesia with local anesthesia or ketamine anesthesia, B-ultrasound or X-ray monitoring, take the prone position, the affected side elevation 30 °, in the lateral margin of the sacral spinous muscle on the 12th margin for 0.5cm skin incision, 6 -7 intracardiac needle, up to the kidney fat capsule with respiratory swing, a sense of loss that enter the kidney, can be aspirated urine. Remove the needle according to the depth and orientation of the trial after the replacement of the abdominal puncture needle, into the same depth after removal of the needle core, urine overflow, quickly inserted into the F8-12 silicone needle catheterization, patency with 4 Suture silk and fixed fistula tube.