Some renal diseases show surgical treatment on the organs. Thus, in tumorous processes, for example, often there is a need for nephrectomy. What is the specificity of this treatment and how is it done?
Nephrectomy
Surgical removal of the kidney, performed with formations of various types, is called nephrectomy. During the removal, the adrenal gland surrounding the adipose tissue, regional lymph nodes, is also captured. Kidney removal allows people to live a completely normal life, observing only a few restrictions.
Such an operation is often necessary to save the life of a cancer patient.
Types of
Nephrectomy has several classifications. In accordance with the volume of produced removal, the nephrectomy happens:
- Radical or total - when the kidney and tissues around it are completely removed. It is indicated for large cancers;
- Simple - when the donor kidney is removed for further transplantation;
- Partial( resection) is an organ-preserving removal option, involving the excision of part of the kidney. Partial nephrectomy is performed with local lesions of parts of the organ.
The nephrectomy differs according to the access. The operation is laparoscopic or open. Laparoscopic intervention is performed through small openings into which a probe with a camera and instruments are inserted. With open( cavitary) operation, all manipulations are carried out through a 12 cm long incision. Depending on the location, nephrectomy is divided on the left and right sides.
Indications
Nephrectomy is indicated in various clinical situations:
- In cancers localized in one kidney, the second kidney should be at least partially preserved.
- Necrosis, which developed as a result of purulent lesions on the background of urolithiasis.
- Traumatic lesions that led to irreversible kidney dysfunction.
- Hydronephrosis, leading to atrophy of renal tissues. Surgery is indicated in cases where the kidney becomes more than 20%.
- Abnormal abnormalities in kidney development in children, in which the risk of dangerous consequences persists.
- Polycystic in combination with insufficiency. Surgical removal is indicated when a conservative approach to treatment is ineffective. But in this situation it is recommended not just removal, but further transplantation.
Contraindications
There are a number of factors in which nephrectomy is contraindicated. To those include:
- Problems with blood-tightness;
- Single kidney;
- Presence of second kidney lesions;
- Decompensation of diabetes mellitus;
- Receiving blood-thinning drugs;
- Decompensation of cardiac pathologies, etc.
Preparation of
Preoperative preparation is an important stage that significantly influences the outcome of treatment.
In general, the preparation is as follows:
- ECG, laboratory diagnostics, chest radiography;
- Examination of the patient and obligatory consultation of the nephrologist;
- In addition, ultrasound diagnosis, computer and magnetic resonance imaging, positron emission tomography, etc.;
- Allergic reactions to drugs and other substances are detected;
- On the day of nephrectomy, you can not drink and eat.
Progress of the operation
The flow of the operation depends on its type. When the nephrectomy is open, the patient is fixed with elastic bandages to prevent unwanted body displacement during the operation.
In general, the operation has the following stages:
- A cut is performed under the ribs or between 10-11 edges.
- After a special expander is installed, 12-duodenum and pancreas are fixed.
- Through the incision, the surgeon separates the fascia and fat tissue from the kidney, clamps and sutures the ureter and the renal pedicle.
- Then the kidney is removed.
- If the nephrectomy is performed with a malignant tumor, then the lymph nodes and adrenal gland are removed additionally. This is necessary to prevent metastasis.
For laparoscopic nephrectomy, a catheter is installed in the ureter that is capable of expanding the kidney pelvis and fixing the lumen for a certain distance:
- The patient's body is also fixed;
- Peritoneal cavity is filled with gas;
- In the abdominal wall make the necessary punctures;
- In the puncture at the navel, a tube with a camera is inserted, through which the operation is monitored;
- Then the rest of the toolkit is entered into the remaining punctures;
- Further manipulations are carried out with the help of electroscissors - the vessels and ureter are cut off, and then the kidney;
- The kidney is removed through the largest trocar with a diameter of 1.1 cm.
After laparoscopic nephrectomy, the patient can eat food the next day.
On the video of laparoscopic nephrectomy:
Postoperative period
The patient is forbidden to lie on his back and move sharply the first day after the operation. Such a ban is necessary to maintain the integrity of the seams. To get up and turn around, patients are usually allowed on the second-third day after the operation. If there is a pain in the incision site, then anesthetizing injections are indicated. A few hours after nephrectomy, you can take a few sips of water.
Power is allowed only on the second day. Allowed light chicken broth, cottage cheese or fat-free yogurt. If there are problems with peristalsis, enemas are indicated. For the next 2 weeks, in addition to dieting, the patient is prescribed antibacterial preventive treatment. An important point of rehabilitation is the control of creatinine in the blood. If after the operation the creatinine is elevated, this may indicate complications on a healthy kidney.
During the first 30 days, a special bandage is shown, and after one and a half months you can resume your sex life and return to work, of course, if it is not associated with excessive physical exertion. It is necessary to observe a dietary diet based on the use of vegetable and fruit dishes, rye bread, low-fat meat or fish varieties, sour-milk products.
Complete rehabilitation can last up to a year and a half. All this time the patient is forbidden to lift weights and intense physical activity. Gradually, the remaining organ takes on a double load and adapts to this mode of operation.
Complications of
Nephrectomy, like any other surgical intervention, involves a certain risk of complications. Here it is possible to carry:
- Probability of occurrence of postoperative bleedings;
- Anaphylactic shock;
- Seizure or stroke;
- Infectious complications;
- Pulmonary thrombosis;
- Thrombophlebitis;
- Injury of the peritoneum;
- Pneumonia;
- Intestinal paresis.
It is necessary to carry out medical recommendations that will help to avoid relapse of the tumor, adhesive and hernial processes. The patient will periodically have to undergo a screening with MRI and intravenous urography.
After nephrectomy, disability is given to patients only in cases when they need social protection and long recovery if there is no ability to take care of oneself and normal life, as well as with severe health disorders, which are manifested by permanent disorders.