Ureteral cystoplasty for ureteral reflux

One side of the kidney tuberculosis contralateral nephrotic contralateral hydronephrosis was first proposed by Wu Jieping in the 1950s, and later supplemented by others, so that its pathogenesis and surgical treatment principles and methods are perfected. This late complication accounts for about 16% of kidney tuberculosis patients. After clarifying this theory, some advanced patients in the past have received active treatment. The contralateral kidney and ureteral hydrops of one side of the renal tuberculosis can be caused by the following pathological changes: 1, ureteral stenosis: severe tuberculous cystitis ulcer healing, scarring and narrowing of the inner wall segment. 2, ureteral stenosis: due to tuberculosis urinary continual regurgitation to the contralateral ureter, or lymphatic infiltration between the sheath, the formation of tuberculous stenosis in the lower ureter. This narrow segment is generally within 5 cm of the end. 3, tuberculous contracture bladder internal pressure is often in a high pressure state, resulting in contralateral ureteral orifice dilatation - reflux, the formation of reflux renal, ureteral hydrops. 4, ureteral stenosis and insufficiency: in the formation of ureteral scar stenosis, but also destroy the physiological closure function of the inner segment of the wall, become the common cause of this type of kidney, ureteral hydrops. Curing disease: Indication According to the pathological changes of contralateral ureteral reflux caused by renal tuberculosis, the methods of surgical treatment are also different. Lower ureteral stenosis and stenosis, feasible stenosis and resection of the bladder; stenosis of the bladder to reduce reflux, feasible ileal or sigmoid bladder angioplasty, ureteral anastomosis; ureteral endoplasty only for tuberculous bladder After the inflammation is completely cured, the volume and the bladder wall are basically normal, but the severe effusion hydronephrosis, which is destroyed by the function of the ureteral wall, is uretero-cystoplasty, and there are fewer patients in this type. . Preoperative preparation 1, urethral indwelling catheter drainage. 2. Use antibiotics to control infection. 3. Improve the general condition of the body. Surgical procedure 1, incision and resection of the stenotic ureter Good exposure was obtained in the lower stenosis with an oblique incision of the peritoneal diameter of the ankle (ie Gibson incision) or a rectal abdoministomy of the lower abdomen. Here the following abdominal oblique incision peritoneal outer diameter path is described. The incision begins at 3 cm from the inside of the iliac crest and is slanted down to the pubic symphysis parallel to the inguinal ligament. The skin, subcutaneous tissue, external oblique muscle aponeurosis, intra-abdominal oblique muscle and transverse abdominis muscle were sequentially cut in the direction of the incision, and a small incision was made on the transverse transverse fascia to see the extraperitoneal fat. The peritoneum is pushed up and down by hand to separate from the transverse fascia, and then the inferior oblique muscle and the transverse abdominis incision are enlarged to be as long as the incision. At this point, use the gauze to push the peritoneum up and you can see the iliac vessels. The ureteral stump can be found between the retroperitoneal and the iliac vessels according to their direction of travel, appearance and peristalsis. The ureteral stump was suspended by a needle thread with a needle thread and placed aside. 2, the removal of the ureter The bladder is incision extraperitoneally, the mucosa is opened around the ureteral opening, the ureter between the bladder wall and the ureter at the junction with the bladder are separated, and the bladder wall is detached and excised. After the resection, the bladder wall is a submucosal tunnel. . 3, the lower part of the ureter is placed in the tunnel A curved vascular clamp is inserted through the tunnel incision to the outside of the bladder and the end of the ureter is clamped and pulled into the bladder. 4, ureteral bladder anastomosis The opening of the normal bladder wall is fixed around the ureter wall and the bladder mucosa. The mucosal edge is sutured to the bladder mucosa at the incision, and the 3-0 or 4-0 absorbable line is sutured to form a new opening. About 3cm. 5, place the stent tube, suture the incision The bladder muscle layer and the ureteral muscle layer were sutured by thin wires. The silicone rubber tube or double "J" catheter in the fixed ureter is used for stent drainage, and the bladder wall incision is sutured. If the bladder incision is larger, a temporary bladder stoma should be performed, and the rubber band is drained in the operation area. Suture the abdominal wall incision. complication 1, urinary fistula: ureter residual lesions or ureteral segmentation too much separation, poor blood circulation caused by ureteral ischemic necrosis, eventually urinary fistula. During the operation, attention should be paid to protecting the intact blood circulation of the ureteral adventitia. The operation should be meticulous and gentle, and it is not appropriate to clamp the ureter. 2, wound infection: postoperative attention to adequate drainage in the surgical department, more can avoid the occurrence of wound infection.