ureteropelvic anastomosis

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: repeated pelvic ureteral malformations Indication The ureteral ureteral side anastomosis is suitable for the ureter placed in the renal pelvis, the opening is too high, the fistula junction is narrow, or limited to a small segment of the ureteral stricture, the renal pelvis expansion is not serious, do not need to do partial resection of the renal pelvis. Surgical procedure After the renal pelvis, ureteropelvic junction and upper ureter were freely exposed, the distal part of the renal pelvis and the distal end of the ureteral stricture were fixed with suture. The incision starts from the lowest position of the renal pelvis, that is, near the renal parenchyma, and passes through the fistula connection, and is folded down along the entire stenosis of the ureter. The length of the incision of the renal pelvis and the ureter is horseshoe-shaped. The medial edge of the posterior wall of the renal pelvis and the ureteral incision was sutured with a 4-0 or 5-0 absorbable line. Place the ureteral stent tube and the renal pelvic stoma. The two sides of the front wall are sewn in the same way. A second layer of suture was pulled slightly with a loose renal pelvic wall to cover the anastomosis and push the kidney up. The rubber tube is drained under the anastomosis, pulled out by the waist incision, and the lumbar incision is sutured according to the layer.

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