| Hydronephrosis caused by ureteral obstruction which work by various diseases the urinary systemts djacent that abnormal renal function and then cause serious risk of renal failure can lead. trasound-guided percutaneous nephrostomy tube (PNT)insertion become one part of the solution simple and effective treatment method, especially in the result of obstruction caused by impaired renal function should be considered the first choice of treatment ? Although ultrasound-guided percutaneous nephrostomy tube (PNT)insertion could encou- ntered some complications .even the major complications. But the complic- ations could be cured.contrast to the tradiaion ways that Laparotomy or radiologic–guide.ultrasound-guided percutaneous nephrostomy tube (PNT)inse- rtion safe, speedly, lower complication rate and economical .Objective : To investigate the clinical value of ultrasound-guided percutaneous nephrostomy ( PCN) in patients with post renal uremia. Study the ultrasound-guided PCN treatment and prevention of complications.Materials and methods:1. Collected in our hospital 2007.9 ~ 2010.3 on 76 cases of hydronephrosis on patients, including 65 cases of unilateral hydronephrosis, bilateral hydronephrosis in 11 cases, a total of 87 side of the kidney. 35 patients, renal function changes, creatinine and blood urea nitrogen were higher than normal. 20 patients required a permanent band tube.2. Preoperative examination of the patient accordingly, to understand physical condition of patients, exclusion of contraindications to percutaneous gastrostomy to assess the severity of hydronephrosis, select the appropriate puncture point and the puncture path.3. Preoperative skin, ultrasonic probe disinfection, local infiltration anesthesia, using the PTC needle or Y-type needle, under ultrasound guidance to avoid the important organs and blood vessels, puncture of renal pelvis into the expansion within the drainage through the wire to tube placed, drainage and decompression, to relieve the obstruction.Results and Discussion:1. A puncture in all patients were successful, the success rate of 100%; catheter significantly improved renal function after, 94.3% of renal function in patients with significant improvement after 3 days, 7 days after return to normal.2.14.4% of patients had complications, 4 patients had bloody drainage fluid, considering the damage caused by renal artery; two cases of postoperative fever, infection due to consider; two cases of patients with blocked drainage, 1 case in the treatment of 3 weeks after drainage reduction, ultrasound examination revealed hydronephrosis, and 1 to 4 weeks after catheter drainage tube was completely blocked; 3 patients in the treatment of drainage tube after accidentally fall off. All patients with complications were given appropriate treatment, patients with bleeding injection of hemostatic agents and local hemostasis; infection in patients with renal pelvis irrigation with antibiotics while intravenous antibiotics; drain plug to shift patients to adjust location of drainage, relocation tube.3. The patients were followed up for two years without a case of nephrostomy complications or kidney failure and died.Conclusion:1. Ultrasound-guided percutaneous nephrostomy of the various causes of hydronephrosis caused by ureteral obstruction and has good effect, can effectively relieve the obstruction, the protection of renal function, to create conditions for further treatment, you can always catheter , as a long-term treatment of urinary diversion.2. Relative to other treatment methods, and other guidance, ultrasound-guided percutaneous nephrostomy safe, monitored in real-time ultrasound can effectively avoid the important organs and blood vessels, reduce complications.3. Ultrasound-guided percutaneous nephrostomy for ureteral obstruction caused by improving renal failure has a very important clinical significance. Conclusion:Ultrasound-guided PCN is a safe and effective procedure for patients with obstructive uropathy. |
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