Resection and release of fibrous tissue at the ureteropelvic junction

In the etiology of hydronephrosis, the obstruction of the renal pelvis-ureter junction is the most common, mostly caused by various congenital dysplasia. Most of the hydronephrosis in children and adolescents is this type. There are many specific causes of obstruction, but there are two types: 1 intraluminal stenosis, including dysplasia of muscle tissue, proliferation of fibrous tissue, diaphragmatic diaphragm, ureteral distortion with renal insufficiency, ureteral placement of renal pelvis The mouth is too high. 2 external pressure in the lumen, common with fibrous adhesions, abnormal renal blood vessels caused by the formation of kinks or flexion at the junction of the fistula. When the muscle fiber is dysplastic or lacking, the peristaltic wave conduction from the renal pelvis-kidney is blocked, which can be one of the important factors of obstruction of the fistula. The cause of this obstruction is often not single, but comprehensive. Therefore, in the surgical treatment of this obstruction, it is necessary to consider the removal of the organic obstruction seen by the naked eye, but also the possibility of neurotransmitter. In the past, various surgical methods have been designed to relieve this obstruction, but the choice of surgical procedure should be based on the lesion and the specific circumstances of each patient. Curing disease: Indications exist in the connective tissue band around the junction of the fistula, often the ureter is confined, displaced, twisted and obstructed, surgically remove the fiber band, free release of the ureter, often can block the obstruction, kidney The accumulated water gradually disappeared. However, this type of tube-fiber bandectomy is limited to a shorter course of disease, a lesser degree, a normal development of the ureter itself, and no significant stenosis in the lumen. Such cases are quite rare in clinical practice. The indications for this surgery should be strictly controlled. Preoperative preparation It is the same as the preoperative preparation for general kidney surgery. Surgical procedure The inferior pole, the renal pelvis and the upper ureter were exposed through the lumbar incision, and all the fibrous adhesions were separated and ligated, and the junction of the renal pelvis and ureter was completely freed. At this point, the compressed ureter can be seen to expand. As the corpus callosum contracts, the peristaltic wave is transmitted to the ureter through the renal pelvic opening, and the urine is transported downwards one by one. Touch the kidney fistula and ureteral cavity with your hand, the wall is thin and soft. If the renal pelvis contraction force is poor, it can be supplemented by vascular clamp stimulation, or rapid intravenous input of diuretic. When the full kidney tachycardia is empty, it means that the operation has been relieved, and it is not necessary to cut the renal pelvis for further treatment. . After the rubber band is drained in the operation area, the waist incision is sutured layer by layer.

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