Peloplasty

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. The surgical approach often uses a lumbar incision, or the anterior abdominal incision of the peritoneal outer diameter road, or the lumbar and abdomen combined incision of the peritoneal outer diameter road, so that the kidney and the ureter can be well exposed. In the free subrenal pole, renal pelvis, fistula junction and upper ureter, pay attention to the presence or absence of abnormal blood vessels to supply the inferior pole, can not easily cut the ligation, try to retain the nutrient vessels of the wall. After the lesion is examined clearly, the surgical plan is determined, and the surgical procedure is gradually completed according to the selected angioplasty. Epidural anesthesia is usually used for surgery, and general anesthesia is used for children. Whether the stent tube and the renal pelvis drainage tube are placed after the formation has been a controversial issue. It is believed that the ureteral stent tube has the following advantages: the separation of the anastomosis is beneficial for growth without sticking, the desired lumen can be maintained, the ureter is kept vertical without twisting and twisting, and the anastomosis is prevented from overflowing; It is thought to cause infection, which can cause ureteral mucosal erosion in non-stenosis areas. In recent years, the use of double "J" tubes with thinner diameters can overcome the shortcomings of stent tubes. Most surgeons have been using stent tubes after post-molding. There are also two opposing opinions for the use of a renal pelvic drainage tube after and after angioplasty. The application of the nephrostomy tube can effectively clean the clot, the necrotic protein coagulum, etc., and has the function of fixing the kidney. When the anastomosis is blocked, the safety of the valve can be safely performed, and the sputum can be performed or performed through the stoma tube. Some technical operations. Its shortcomings also introduce infection, destroy the kidney tissue around the pipeline, and reduce the peristaltic function of the renal pelvis. Most people still use a renal pelvic drainage tube after surgery. For the isolated kidney, the renal pelvis should be used without the renal stoma. The former method can not only retain the functional renal parenchyma, but also avoid the hemorrhage of the renal parenchyma and even the risk of intrarenal arteriovenous fistula. After the angioplasty is completed, renal fixation should be performed, and the kidney should be placed in the normal position as high as possible. Under the direct vision, the anastomosis should be observed without distortion and arranged into the best drainage position. Even experienced surgeons have a higher failure rate for the first or re-plasty. The regular follow-up of the operation after surgery is not negligible. This spiral pelvic wall pyeloplasty was designed by Culpos. Treatment of diseases: ureteropelvic junction obstruction Indication When the ureter and ureteral junction part of the ureteral stricture is longer, the lingual renal pelvic wall pyeloplasty or the tongue wall flap is not enough to repair the stenosis defect, a spiral long tongue-shaped renal pelvic wall pyeloplasty can be used. Surgical procedure 1. Reveal the entire dilated renal pelvis and upper 1/3 ureteral segment. An incision is made from the lower end of the ureteral stenosis segment, and the entire length of the stenosis segment is opened, and the patellofemoral junction continues to extend upward toward the renal pelvis. According to the length of the stenosis, the incision of the renal pelvis wall can continue to spiral upward and then take the required width. The incision is folded down and down to the lowest part of the renal pelvis to form a full-length long tongue-shaped wide pedicled renal pelvic wall flap. 2. Turn the renal pelvic wall flap and pull it down so that its tip is aligned with the lower edge of the ureteral incision and the posterior wall is sutured. 3. After the posterior wall is sutured, the ureteral stent tube and the renal stoma tube are placed. 4. Finally, suture the anterior wall of the renal pelvis, such as the renal pelvis is still too large, and then trim the part of the renal pelvis wall. The other side edge of the renal pelvic wall flap was sutured to the incision edge of the ureteral wall, and the suture was lined with a 4-0 absorbable line. Renal sutures often require two layers of reinforcement.

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