Pyelolithotomy

Treatment of diseases: urinary stones Indication The pyelolithotomy is suitable for: The pyelolithotomy is the most common method for removing kidney stones. The operation is simple and safe, and there is less bleeding. It is suitable for the renal pelvis stone, or the diameter of the renal pelvis stone is smaller than the width of the renal pelvis neck. It is especially suitable for the extrarenal renal pelvis, and the stone can be removed by the extrarenal renal pelvis. Surgical procedure 1. Incision and exposure of the kidney through the 12th rib incision, generally can fully reveal the renal pelvis. Cut the skin, subcutaneous and various layers of muscles in turn until the kidneys. 2. Incision of the renal pelvis, simple renal pelvis and open stone removal do not need to completely free the kidney, only the lower kidney and the upper ureter can be free. The ureter is lifted with a rubber sheet or a thin catheter, separated upward along the ureter, and the adipose tissue on the dorsal surface of the renal pelvis is separated on the dorsal side of the kidney to reveal a smooth pelvic adventitia. On both sides of the incision line of the renal pelvis, a 1-needle pull line was sutured with a fine needle No. 0 silk thread, and then the renal pelvis was cut along the longitudinal axis. 3. Remove the renal pelvis stones and gently lift the traction line. If the stones are under the incision, gently remove them with a stone pliers under direct vision. If the stone is in the renal pelvis, the stone can be inserted into the renal pelvis through the incision. After the stone is touched, it can be accurately clamped. 4. Remove the renal pelvis stone If the stone is located in the renal pelvis, do not blindly clamp the stone, you should first gently insert the small finger into the renal pelvis, touch the number, size and position of the stone. If the adhesion between the stone and the renal pelvis mucosa is tight, you can use the finger to slightly loosen it, and then use the stone clamp with different curvature according to the stone part, carefully remove the stone carefully. 5. After the stone is removed, the integrity, size, shape and number should be carefully examined and carefully checked with the preoperative X-ray film to check for residual small stones. If there is suspiciousness, it should be reviewed on the operating table. 6. Flush the urinary tract to confirm that the stone has been completely removed, use the F8 ~ 10 catheter into the renal pelvis, rinse repeatedly with warm saline, pay attention to the presence of fresh bleeding or old blood clots in the kidney. A catheter or ureteral catheter was then inserted into the ureter from the renal pelvic incision to the bladder for ureteral obstruction. 7. Suture incision The renal pelvic incision was sutured with a 4-0 absorbable line interrupted suture, and the anterior renal pelvis was sutured with a 0-wire suture to reinforce. Generally do not make a renal fistula. If the renal pelvis mucosa is inflamed, the edema is heavier, or the oozing blood is more obvious after taking the stone, a temporary pelvic stoma can also be made. After rinsing the incision, a rubber tube is placed in the vicinity of the renal pelvic incision, and the incision is closed layer by layer.