Renal tuberculosis foci debridement

Surgical treatment of renal tuberculosis is to clear the lesion and shorten the treatment time. According to the extent of lesions, the extent of organ damage, renal tuberculosis, partial nephrectomy, nephrectomy, renal and ureteral resection, contralateral hydronephrosis surgery and surgical treatment of contracture bladder. Treatment of diseases: kidney tuberculosis Indication Kidney tuberculosis resection is suitable for: 1. Close to the surface of the kidney, a large closed tuberculous abscess, the neck of the renal pelvis is closed, other parts of the kidney are free of visible tuberculosis, or mild lesions may be cured. 2. Solitary tuberculous abscess in the orphan kidney or bilateral kidney. Contraindications 1. Multiple tuberculosis abscesses in the kidneys and disseminated tuberculosis lesions throughout the body. 2. Abscess rupture penetrates the renal pelvis, renal pelvis, ureter and bladder lesions significantly, the contralateral renal function is normal, no obvious lesions. Preoperative preparation Anti-tuberculosis drugs should not be treated for less than 3 months. At least 2 drugs or 3 drugs are used in combination. The average dose is: rifampicin 600mg (8 ~ 10mg / kg), isoniazid 400mg (5 ~ 8mg / kg), ethambutol 1600mg (25mg / kg), or streptomycin 0.5g, 2 times a day It is also possible to use a single administration method in the morning. Surgical procedure 1. Incision: The oblique oblique incision or the eleventh intercostal incision was used to cut the layer by layer to reveal the kidney. 2. Expose the lesion area If the adhesion around the kidney of the abscess is heavier, it should be carefully separated. The rest of the kidney does not have to be exposed too much and is covered with gauze. Then puncture the pus with a syringe, and when the abscess collapses, it can show the extent of the tuberculosis. 3. The abscess is removed from the top of the abscess with a forceps. The top of the abscess is cut off along the edge of the normal renal parenchyma, so that the abscess is completely open. The wall of the abscess is gently wiped with a wet saline gauze to remove all the cheese-like material, revealing the abscess. The inner wall of the fiber. 4. After suturing the top of the abscess cavity at the edge of the abscess, the incision margin of the abscess is made by continuous suture or intermittent suture with the No. 4 gut, so that the residual cavity is open to a disc shape. The oozing at the bottom of the abscess can be stopped by hot saline gauze. 1 g of streptomycin powder was sprinkled into the lesion, and the residual cavity was filled with perivascular adipose tissue with blood vessels, and the suture was fixed. 5. After the free kidney, properly reset and fix. There is no need to place a flushing tube or a drainage strip for the wound. The incision is sutured by layer complication 1. Kidney-period tuberculous sputum is caused by incision contamination during surgical operation and renal wound exudate complicated by infection. After local treatment or dressing change, it can heal more. Once the sinus is formed, it should be surgically removed. 2. Secondary bleeding due to surgical rough removal of the abscess, causing bleeding or bleeding of small blood vessels. Generally, more can stop on their own; uncontrollable bleeding, need to stop bleeding or eliminate hematoma. 3. Perirenal abscess due to abscess pus spilled in the kidney, a large amount of exudation of kidney wounds can easily lead to perirenal infection, or after the formation of abscesses, more often low back pain, long-term low fever, weight loss, loss of appetite, etc., affected side If the muscles are tense, tender, or touch the tumor, the drainage should be cut in time.