lingual pelvic wall flap pyeloplasty

If the obstruction of the ureteropelvic junction is not relieved by the above surgery, it is often necessary to reconstruct the new opening of the fistula to obtain a good normal drainage of the renal pelvis. Although there are many methods of pyeloplasty, the basic point is to use the wide wall of the renal pelvis to repair the lumen diameter of the stenosis, and at the same time to achieve the reduction of the renal pelvis cavity at the lowest part of the ureter. Make the fistula mouth funnel shaped. Surgical technique generally uses cutting the junction of the renal pelvis and the ureter, re-synchronizing after trimming, or not cutting the joint, and only using the various renal pelvic wall flaps to supplement the part of the wall of the narrow segment. Such angioplasty is more complicated than those described above. If there are no technical problems, the surgical effect is more certain. Renal pyeloplasty has been used for the treatment of hydronephrosis for a hundred years, but by the middle of the 20th century, there have been new reports of methods, but there is no stereotype as the only treatment for stenosis of the ureteropelvic junction. This is due to the different extent of the disease, but the experience and application habits of each urologist are also important factors. The anastomosis of the ureter and ureter is cut off. Although it has the advantage of completely removing the dysplasia wall, it is suitable for the anastomosis of the ideal part after the cut, but also the hemorrhage of the ureter and ureter is serious, affecting the healing of the anastomosis, leading to surgery failure or urinary fistula. possibility. The anastomosis of the ureter and ureter is not cut off. Although some of the blood circulation and urinary tissue are preserved to facilitate the healing of the incision, when the stenosis is too long, the pedicled renal pelvic wall flap is difficult to repair and cannot be completely removed. Dysplasia, it is inevitable that postoperative peristaltic wave conduction is blocked. Although the two types of methods have shortcomings, they can be compensated by some technical improvements. For example, when the ureter is cut, the intrinsic blood vessels from the renal pelvis and the anastomotic branches of the upper ureter are preserved. The spiral pelvic wall flap can prolong the repair of the long ureteral stenosis. segment. Treatment of diseases: obstructive nephropathy Indication Tongue-like renal pelvic wall pyeloplasty is applicable to: When the ureteral ureter is released, the obstruction can not be relieved, the stenosis is longer than 1cm, and when the enlarged renal pelvis needs partial resection, this modified Foley pyeloplasty procedure can be used. Surgical procedure After the sputum and ureter are exposed, the connective tissue adhesion around the ureteral junction of the renal pelvis is completely released, and the obstruction can not be relieved. If the stenosis is more than 1 cm, the incision can be designed. The attachment of the renal pelvis to the ureter is not cut. In the course of the excess of the renal pelvic wall to be removed, a suitable wide-length full-thickness pelvic tongue wall flap with a wider pedicle is taken from the appropriate site. After the incision of the renal pelvis, there were no other lesions in the renal pelvis. After the stenosis was completely opened, the ureteral stent tube and the renal pelvic stoma tube were placed. The defect port left after the partial renal pelvis was removed was sutured, and then the tongue wall flap was pulled. , so that its tip is aligned with the lowermost edge of the incision. The tongue wall filling is filled in the open stenosis defect area, so that the lumen is fully enlarged, and the tongue wall flap is taken from the lower part of the renal pelvis wall, and the new opening is at the lowest position of the renal pelvis. If the wall of the renal pelvis is thickened due to long-term expansion, first suspend the layer with a 4-0 absorbable thread, and then strengthen the layer with intermittent suture.

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