Lich-Gregoir surgery

Lich-Gregoir surgery is used for surgical treatment of vesicoureteral reflux. The ureteral junction has a valve function. When the bladder pressure increases, the normal ureteral junction can prevent retrograde reflux of the bladder urine to the ureter. When the ureteral junction is insufficiency, different degrees of vesicoureteral reflux can occur, resulting in ureteral dilatation, and even hydronephrosis, renal parenchyma thinning, especially in the case of infection of the lower urinary tract, vesicoureteral reflux can cause acute Pyelonephritis. Recurrent episodes of hydronephrosis plus pyelonephritis often cause severe damage to renal parenchyma and kidney function. All children with ureteral reflux should be fully examined before surgery to find out whether the ureteral reflux is primary or secondary. Secondary include obstructive diseases such as neuronal or urethral valves. For children with secondary ureteral reflux, the primary disease should be treated first, followed by treatment of vesicoureteral reflux. Since the 1950s, experts have designed many procedures to correct vesicoureteral reflux. The surgical methods can be divided into two categories: 1 surgery is performed mainly or completely in the bladder; 2 surgery is performed completely outside the bladder. Treatment of diseases: vesicoureteral reflux Indication Surgical procedures performed entirely outside the bladder are only used in cases with mild ureteral water. Preoperative preparation 1. Preoperative excretory bladder urethrography, urodynamic examination, bladder urethra microscopy, double kidney B ultrasound, etc., to understand primary or secondary vesicoureteral reflux, if the secondary should first treat the primary disease . 2. Do urine routine and urine bacterial culture, drug sensitivity test, if there is urinary tract infection, you should choose sensitive antibiotics to control infection. 3. Check blood urea nitrogen, creatinine, etc. to understand the renal function, such as severely impaired renal function, you can first indwell the catheter to continue drainage, until the kidney function is improved and then surgery. Surgical procedure 1. Incision: Take the lower pubic transverse incision so that the future incision scar is located in the pubic pubic hair. 2. Exposure: Cut the skin and subcutaneous tissue, reveal the rectus abdominis sheath, separate the rectus abdominis from the midline, push the peritoneum upwards, expose the bladder, check the number, position, shape, peristaltic closure and measurement of the ureteral orifice Tunnel length. 3. Inject saline into the bladder to bulge the bladder. Reveal the bladder, flip forward and to the opposite side. The occlusion of the occluded umbilical artery and a portion of the blood vessel across the ureter are separated. The lower ureter is revealed. Then make an incision in the posterior wall of the bladder. 4. Incision of the bladder muscle layer, pay attention to prevent damage to the mucosa, free to both sides, so that the muscle layer and mucous membrane separation, pay special attention to cut the bladder muscle layer at the junction with the ureter. 5. Place the ureter under the muscular layer, and suture the muscle incision with two layers of sutures. Generally, start from the proximal end of the tunnel, and take care to prevent ureteral stricture caused by over-tightening. complication Leaking urine In cases where the ureter itself is plasticized, leakage of urine is more likely to occur. Generally, as long as the ureteral stent drainage tube and the bladder fistula tube are circulated for a few days, they will stop by themselves. 2. Urinary fistula formation Leaking urine for a long time can form urinary fistula, mostly caused by distal ureter ischemic necrosis. Therefore, attention should be paid to maintain ureteral blood supply during operation, and the stent drainage tube should avoid excessive pressure on the ureteral wall to affect blood circulation. 3. Infection Infections include wound infections and acute pyelonephritis. In order to avoid pyelonephritis caused by retrograde infection, if the ureter itself has not undergone plastic surgery, the stent drainage tube can not be placed. If the ureter itself has been used for incision or plastic surgery, the stent drainage tube should be placed, and the internal drainage method should be adopted, that is, the double "J" shape The tube is placed in the renal pelvis and left in the bladder.

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