Combined renal pelvis and nephrolithotomy

Treatment of diseases: kidney stones Indication The combination of renal pelvis and kidney incision is applicable to: 1. Kidney calculus, stones larger than the renal pelvis neck can not be cut through the renal pelvis. 2. The staghorn calculus incarcerated in the renal pelvis and renal pelvis, which cannot be removed by the renal sinus in the renal sinus. 3. The stone is small and the position in the renal pelvis is not certain. Preoperative preparation Prepare blood for 600ml. Patients with urinary tract infections should be treated first, and surgery should be performed after infection control. Surgical procedure 1 kidney incision and stone removal 1. The incision enters through the 12th ribbed exposure pathway, separating the upper part of the kidney and ureter. 2. Renal spasm, kidney incision exploration in the kidney for two incisions, one in the renal pelvis, one in the renal cortex. The pelvic incision is used for finger exploration of stones. When the incision of the renal cortex is large, the kidney is locally cooled, and then the rubber tube is blocked with a heart ear pliers or a curved clamp to block the blood supply of the kidney, and the blood loss during the operation is reduced (the blocking time should not exceed 30 minutes). Before cutting the renal parenchyma, the needle should be inserted into the stone. When the stone is touched, the needle is kept and cut along the needle with a sharp edged knife. 3. Push the stone through the incision of the renal pelvis and insert the finger. After the exact examination, the stones in the renal pelvis are gently pushed out through the renal parenchyma. 4. Take the stone through the renal cortical incision and extend into the stone pliers. Under the joint operation of the fingers in the renal pelvis, gently clamp the stone and pull it out in the appropriate direction. If the stone is staghorn-shaped, the branch protrudes into the renal pelvis, and the funnel can be gently pulled away by a shank or a hard stripper to help remove the stone. 5. Rinse the renal pelvis and remove the stone. Rinse the renal pelvis with normal saline and flush out the residual small stones. 6. Hemostasis The arch vessels of the vascular, renal cortex and renal medulla junction at the renal pelvis were sutured with a 4-0 gut. 7. Suture the renal pelvis and renal pelvis with a 4-0 gut through the incision of the renal cortex and suture the deep incision of the renal pelvis and renal pelvis, so that the renal incision and the renal pelvis are separated to avoid the bleeding of the renal parenchyma after surgery. In the renal pelvis, causing blood clot obstruction and other after-effects. 8. Loosen the kidney pedicle and hold the renal cortical incision with your left hand. The right hand gradually loosens the heart ampule of the kidney pedicle to observe whether the hemostasis is perfect. If there is less bleeding, you can use the warm saline gauze to stop the bleeding. 9. suture the renal cortex with the intestine line through the suture of the renal parenchyma before and after the periorbital, generally three needles can be sewn, not too much (or suture 2 to 3 needles), and then suture the suture one by one, so that the kidney section The kidney capsule was sutured continuously with a 3-0 gut. If the renal capsule is defective, free adipose tissue may be used to cover the surface of the kidney, and then the suture penetrating through the renal parenchyma may be ligated. 10. Suture the renal pelvis before suturing the renal pelvis, insert the catheter through the pelvis incision for flushing; if there is a small amount of bleeding in the renal pelvis, rinse with iced saline to stop bleeding. After rinsing, the renal pelvis was sutured intermittently with a 2-0 to 3-0 gut. 11. Suture the incision of the renal pelvis with a porous rubber tube and cigarette drainage, suture the lumbar incision. (1) renal pelvis, renal cortical incision, finger exploration stones (2) Use your fingers to reach into the renal pelvis and push the incision out of the stone (3) Peeling the renal pelvis with a hard stripper (4) suturing the renal pelvis and renal pelvis (5) suture the renal parenchyma (6) suture the renal pelvis incision with a free incision covering the renal incision 2 renal pelvis and kidney combined with open stone removal 1. Incision of the renal parenchyma After incision of the renal pelvis, if it is found that the stone can not be removed, the renal pedicle is gently clipped with a renal pedicle (or heart ear pliers) after local cooling, and then the renal pelvis incision is extended to the renal parenchyma in a "u" shape. 2. Take the stone and rinse. After removing the stone from the incision, rinse the renal pelvis and completely rush the stone fragments. 3. Stop bleeding, suture and loosen the renal pedicle, observe whether there is bleeding. If there is bleeding, the renal pedicle should be clamped again, and the bleeding point is sutured with a thin gut. Then release the renal pedicle clamp. If there is no bleeding, the renal pelvis should be washed to remove the blood clot. The renal parenchyma incision is sutured with a thin intestine and is usually not required for pyelolithoplasty. After observing no bleeding, the renal pelvis incision was sutured with a thin intestinal line. 1 (1) block the renal pedicle, expand the incision of the renal pelvis and renal parenchyma (2) remove the stone

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