terminal ureterocutaneous fistula

A ureterotomy is a measure of urine in the upper urinary tract on the side of the drainage surgery. According to different lesions, surgical indications and follow-up surgery after stoma, ureterostomy is roughly divided into two types: 1 ureterotomy; 2 end ureterotomy. The end ureteral skin stoma requires complete severing of the ureter and the introduction of the lower ureter out of the skin to form a stoma, often permanent. However, if you want to rebuild its continuity and restore physiological urination, you can use a bladder wall or intestine to replace the pelvic ureter. Despite this, restoring its continuous surgery is complicated and difficult, and the results may not be ideal. Therefore, when deciding to perform a skin ostomy, it should be fully considered as a permanent urinary diversion. If it is possible to restore continuity in the future, it is best to perform a renal ostomy without disturbing the ureter. End ureterotomy is available in a variety of procedures, depending on the condition. 1. Simple ureteral lower skin ostomy This is the simplest method of ostomy. The ureter is cut off at the appropriate part of the ankle, and the upper stump is placed outside the skin as a passage for urine drainage. This type of treatment is mostly used in patients who are in an emergency and who have to be diverted. This can be done regardless of whether the original condition has been identified. If the patient's general condition is extremely weak, it is judged to be a generalized bladder tumor, causing severe bleeding, or it is initially judged to be a ureteral end or bladder lesion, which has caused severe renal failure. It is necessary to undergo long-term drainage or to determine that the bladder cannot be preserved. This procedure. For patients who have been diagnosed with a disease that requires urinary diversion, weigh the pros and cons, and after careful consideration, the ureter can be used as a permanent treatment or a temporary transitional measure. However, if the treated ureter is to be used as a drainage channel for reoperation, the length may be insufficient. If the ureter is to be reused in the next operation, it is better to first make a renal stoma. It is advisable not to affect the ureter. Although this type of external surgery is very simple, it has major drawbacks, especially in the case of permanent urinary diversion, which is not widely used. The disadvantages are: 1 simple ureteral external catheter must be inserted into the catheter to drain urine, which brings many troubles to the patient; 2 can cause inevitable retrograde infection; 3 does not intubate and use any type of urine collector Ideally, in addition to leakage of urine, the skin around the orifice often causes inflammatory irritation; 4 stenosis may occur after the external ureteral orifice, which will have a serious impact on the replacement of the catheter and maintenance of renal function. 2. Skin nipple ureterostomy This procedure also has a variety of procedures, which use the skin near the incision to wrap around the end of the ureter to form a nipple, which is convenient for collecting urine. 3. A pedicled ureteral ostomy is performed to form a pedicled tube on the abdominal wall of the lower abdomen, and the end of the ureter is drawn out through the formed skin tube and opened at the tip end of the skin tube. Because the skin tube is formed, the end of the ureter is longer than the skin nipple, making it easier to collect urine. Treatment of diseases: Bladder tumors Preoperative preparation 1. If there is imbalance of water and electrolyte balance, vitamin deficiency, severe anemia, etc., treatment should be given first. 2. For those who have not resected the bladder, insert a catheter to empty the urine in the bladder. Surgical procedure 1. Simple ureteral lower skin ostomy Oblique oblique incision of the lower abdomen, the ureter is exposed extraperitoneally. Free ureter, pay attention to anatomy slightly away from the wall, to avoid detaching the ureter, and damage the blood supply. The diseased ureter was removed to a healthy location. At a suitable position inside the original incision, a small elliptical skin is removed to form a small hole in the skin and penetrate the incision. The free ureter is tuned to adjust the direction of the ureter to reach the skin, and the ureteral orifice is aligned with the edge of the nip to complete the ostomy. Note that this segment of the ureter must be gradually flexed to reach the opening to avoid sudden bending or being pulled by adjacent tissue, otherwise the intubation will be difficult later. In addition, the ureter must be kept full length without tension after external positioning. Otherwise, the ureter retracts and the orifice is invaginated or narrowed after the operation, which may cause great trouble due to leakage of urine near the outlet. The ureteral opening and the edge of the skin can be sutured intermittently to form an anastomosis. However, it is best to pull the ureter a little more, firstly fix the ureter wall at the edge of the skin puncture, and then eject the small ureter that is higher than the skin, forming a cuff-like end shaped like a small nipple and then sutured. This method of stoma can avoid the narrowing and retraction of the ureteral stoma. 2. Skin nipple ureterostomy This method has a variety of surgical procedures. It is relatively simple to make two parallel skin incisions in the appropriate part. The lateral incision is slightly extended downward. The distance between the two incisions is 1.5 to 2 cm, and then the subcutaneous tissue is free. The range should be slightly larger than this incision. Use two fingers to push the center of the incision to the center. The skin between the two incisions forms a raised flap, and the skin is pierced at the tip of the raised part, and a small piece of skin is cut. The hole is used as a ureter. Where it is. Then, the protruding flap is fixed and sutured, and the ureteral orifice is matched with the skin puncture to form a skin nipple. The method of exposing and freeing the lower segment of the ureter is the same as above. Another method is to cut the skin incision into a bow shape, and the center of the incision is made into two tongue-shaped flaps which are mutually equal, the two flaps are close together to form a nipple, the ureteral orifice is pulled out from the anastomosis, and the indwelling catheter is inserted. . 3. pedicled ureterostomy This procedure can be performed in two phases. In the first stage, the pedicle tube is placed in the appropriate part of the lower abdomen. After the skin tube is mature (good blood supply), the lower part of the free ureter is dragged into the skin tube and opened at the tip of the skin tube. If the flap is taken well, the operation can be completed in one stage. Two parallel skin incisions are made to form a flap, which is subcutaneously freeed and then rolled into a cylindrical shape to form a skin tube. The length-to-width ratio of the desired flap is not more than 1.2:1 at most, and the narrow and long flaps provide poor blood supply at the end after the formation of the skin tube. In the future, the outer diameter of the skin tube is the width of the flap. When designing the width of the flap, the subcutaneous fat should occupy a certain space in the lumen after the skin tube is formed. Therefore, the actual width of the flap should be appropriately increased according to the size of the ureter. Properly plan and arrange specific dimensions and locations. The defect of the skin below, the surrounding skin, subcutaneous free, and then the center of the suture cover. The lower end of the sheath is cut to form a single pedicle. The stump of the lower ureter is pulled out through the center of the skin tube and fits over the stump of the skin tube, forming a nipple-shaped stoma.

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