Nephrectomy for non-malignant disease

Non-malignant disease nephrectomy for surgical treatment of kidney disease. The kidneys are located on both sides of the lumbar spine, behind the peritoneum of the posterior wall of the abdomen, and close to the posterior wall of the abdomen. The right kidney is about 1 to 2 cm lower than the left kidney due to the influence of the right lobe of the liver. The location of the kidney can vary depending on size, gender and age. The younger the age, the lower the position, and the lower pole of the neonatal kidney can reach the level of sputum. The posterior upper part of the kidney is adjacent to the diaphragm and is adjacent to the rib sinus and the 11th and 12th ribs of the diaphragm and pleural cavity. When performing kidney surgery, care should be taken to avoid damage to the pleura and cause pneumothorax. Both upper kidneys have adrenal coverage. The front of the kidney is different from left to right, the right upper part of the right kidney is attached to the right lobe of the liver, and the lower part is adjacent to the right curvature of the colon. The medial edge is adjacent to the descending part of the duodenum, and there is no peritoneal septum. The right renal vein is short, and the right kidney is adjacent to the inferior vena cava. Care should be taken to avoid damage to the inferior vena cava and duodenum during surgery on the right kidney. The upper part of the left kidney is adjacent to the fundus and spleen, the front of the middle part has a pancreatic tail crossing, and the lower part is adjacent to the jejunum and colon left curvature. Renal surgery through the lumbar incision requires an understanding of the anatomy of the lumbar fascia and its surroundings. The lower back fascia is divided into two layers, shallow and deep. The shallow layer is thick, covering the shallow surface of the sacral spine muscle. The posterior part is the lower posterior serratus and latissimus dorsi; the deep layer is located in the deep surface of the iliac spine muscle and the lumbar muscle is shallow. The upper part is thickened to form a lumbar ligament ligament, which can increase the activity of the 12th rib after cutting, and is convenient for revealing the kidney. The deep part of the lumbar ligament has a pleural reflex. When the lumbar ligament is cut open on the inside, care should be taken not to injure the pleura. The deep and shallow layers of the lumbar fascia are fused on the lateral side of the iliac spine muscle to form the tendon of the transverse abdominis and the internal oblique muscle. Treatment of diseases: hydronephrosis polycystic kidney Indication In children, the kidneys have a significant ability to restore function after the obstruction is relieved. In reflux nephropathy, a part of the kidney can present local hyperplasia. These all lead to a reduction in the number of nephrectomy in children. However, the following conditions are still indications for nephrectomy: 1. Severe hydronephrosis, kidney parenchyma is as thin as a cyst wall. 2. Severe polycystic kidney disease. 3. Congenital non-developed kidney. 4. Severe refractory nephropathy on one side, especially when complicated by hypertension. 5. The kidney is destroyed by infection, such as suppurative nephropathy, yellow granulomatous pyelonephritis, kidney tuberculosis, etc. 6. Severe kidney damage. When considering a side nephrectomy, it must be considered whether the contralateral kidney has sufficient renal function to sustain life. In the presence of the contralateral normal kidney, a kidney with less than 10% to 15% of total renal function assessed by radionuclide or the like may have no retained value after the obstruction is removed. If the contralateral kidney is not normal, nephrectomy should be very careful. Surgical procedure 1. Incision: If a lumbar incision is made, the rib border or the eleventh intercostal incision is generally taken, and it is inclined downward to the inner side of the anterior superior iliac spine about 2 cm, and the posterior end of the incision should not exceed 2 cm of the 12th rib tip. 2. Cut the subcutaneous tissue and the various muscle layers of the waist layer by layer, including the latissimus dorsi, the external oblique muscle, the intra-abdominal oblique muscle and the transverse abdominis muscle, and the posterior serratus muscle. Open the transverse fascia at the posterior end of the incision and push the peritoneum forward with your fingers. Care should be taken to prevent peritoneal injury. If the peritoneal damage is found, it should be sutured. If the eleventh intercostal incision is used, the intercostal muscle should be cut at the upper edge of the 12th rib, and a part of the diaphragmatic foot should be cut, but the pleura should be prevented from being damaged. Once it is damaged, the pleural gas should be taken out with a catheter and sutured and repaired. 3. Incision of the periorbital fascia around the kidney, and then push the kidney around the fat to reveal the kidney. The surgeon bluntly strips the anterior, posterior and upper poles of the kidney along the surface of the kidney. When separating the upper pole, it should be close to the renal surface operation to avoid damage to the adjacent adrenal glands. When there is a suspected accessory renal blood vessel in the upper and lower poles of the separation, it should be clamped and ligated. 4. Free all kidneys until the kidneys. The ureter was separated and lifted, the clamp was cut as low as possible, and the distal end was ligated with a silk thread. After the renal pedicle is clamped with 2 renal pedicles and 1 long curved vascular clamp (for the proximal renal end) or 3 long curved vascular clamps, the renal artery and vein are cut off between the two vascular clamps adjacent to the renal hilum. Renal vascular stumps are ligated with thick threads and sewed through each other. The wound is placed at the discretion of the cigarette, and the incision is layered. complication When there is inflammation or adhesion, nephrectomy is easy to damage adjacent tissues and organs, resulting in more serious complications. The right side may damage the inferior vena cava, causing fatal bleeding and damage to the duodenum, causing duodenal fistula. The left side may damage the spleen and pancreas, but the chance is less than the right side.