Renal and ureterectomy for renal pelvis cancer

Renal sputum cancer accounts for 7% to 8% of all kidney tumors. The incidence of renal pelvic cancer is higher in China, up to 20%. Most of them are transitional cell carcinoma, and a few can be squamous cell carcinoma and adenocarcinoma. It is urinary epithelial. The tumor is homologous to the bladder and ureteral cancer, and the cause is similar. The onset of the disease can be multifocal, and the bilateral upper urinary tract system can have multiple lesions at the same time or in succession. Therefore, many scholars have proposed partial resection of some of the early renal pelvis and ureteral cancer to preserve the kidney and ureter, especially for patients with isolated kidney or both kidneys. In the middle and late stage lesions, the renal, ureteral and partial ureteral resection of the bladder wall should be performed. Treatment of diseases: renal pelvic cancer Indication Renal and ureteral resection of renal pelvic cancer is applicable to: 1. Renal pelvic cancer or ureteral cancer. 2. The ipsilateral upper urinary tract multi-source tumor, including multiple papilloma. Preoperative preparation 1. Intravenous pyelography to understand the location of the lesion and the upper urinary tract, and to understand the contralateral renal function. 2. Urine exfoliative cytology. 3. CT and B-ultrasound to understand the infiltration of the tumor to the surrounding area. 4. Other routine preoperative examinations. 5. Cystoscopy and retrograde urography, if necessary, ureteroscopy to understand the existence of multifocal lesions. Surgical procedure 1. The incision was performed through the eleventh intercostal space or through the 12th rib waist oblique incision to remove the upper segment of the kidney and ureter. The curved lower incision of the lower side of the affected side was performed in the lower ureter and the ureteral orifice. Some scholars advocate the use of an electric resectoscope to make a circular incision 1.5 cm around the ureteral orifice of the affected side, and then remove the kidney and the whole ureter from the lumbar incision, eliminating the incision of the lower abdomen. 2. The lumbar incision enters the retroperitoneal cavity and the perirenal fat sac is cut. First, the lower part of the inferior pole and the upper part of the ureter are separated, and the ureter is tied with gauze to prevent the cancer cells from being planted distally. The renal pedicle is then exposed to the superior renal pelvis and the anterior and posterior sides of the kidney. The upper two renal pedicles were ligated with a 7-gauge thread after transection of the renal pedicle, and the renal pedicle was sutured with a 7-gauge thread. Completely free kidney, only the ureter is connected to the body. Clear the lymph nodes next to the kidney. 3. The ureter is bluntly separated along the upper part of the ureter until the iliac crest is placed. The kidney and the free ureter are placed in a sterile glove and tightly threaded, and inserted into the pelvic cavity as much as possible to pull out from the oblique incision; or try to The ureter is freed and cut off. The kidney and the upper ureter are removed first. The distal ureteral stump is ligated and the longer tail is used as a marker to facilitate the identification of the complete ureteral stump in the lower abdominal incision. After suturing the lumbar incision, change the supine position. 4. The lower abdomen "L"-shaped incision, in turn cut the skin, subcutaneous tissue, open the external oblique muscle aponeurosis, bluntly separate the muscle layer below it, cut the transverse fascia, push the peritoneum to the midline and enter the retroperitoneal pelvic space . Pull the kidney and ureter out of the incision and fully free the lower ureter to the bladder wall. Bluntly separate the bladder muscle of the ureteral bladder wall to the bladder mucosa, fully free the ureteral end and pull the ureteral opening out of the bladder. Use an electric knife to cut the bladder mucosa around the ureteral opening 2 to 3 cm, and completely remove the kidney and ureter. segment. 5. The bladder mucosa was sutured with a 2-0 absorbable thread, and the muscle layer of the bladder wall was sutured intermittently with a 4th wire. The incision was rinsed with distilled water, the wound was not placed in the drainage strip, the incision was closed, and the catheter was indwelled.

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