ileal ureterectomy

Ilemic ureter is a surgical procedure for the treatment of urinary system diseases. When all or most of the ureter is caused by trauma, inflammation, tumor or congenital giant ureter causing ureteral stricture and water above the obstruction, the ileum can be used instead of the ureter, connected between the renal pelvis, renal pelvis, ureter and bladder. Treatment of diseases: pediatric huge bladder - huge ureteral syndrome ureteral tumor Indication When all or most of the ureter is caused by trauma, inflammation, tumor or congenital giant ureter, ureteral stricture and obstruction above the ureter, the ileum can be used instead of the ureter, connected between the renal pelvis, renal pelvis, ureter and bladder. Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation 1. On the 3rd day before surgery, enter a high-calorie, high-protein, low-slag diet to strengthen nutrition; 24 hours before surgery to give a fluid diet (double). 2. Sulfonamide 1g, 4 times a day, for 3 consecutive days. Or oral streptomycin was started 36 hours before surgery, 0.5g every 6 hours. 3. A few days before surgery, 200ml saline can be enema once, so that it stays and walks down to test whether there is no incontinence. 4. For 48 and 24 hours before surgery, each serving was 15 ml of castor oil. On the 2nd day before surgery, 2000ml of warm saline was used every night. Two hours before surgery, 500 ml of 1% neomycin was used for rectal enema to remove intestinal dirt. 5. Blood potassium, sodium, chloride and co2 binding. Surgical procedure 1. Position: supine position. 2. Incision: If the bilateral ureters need to be replaced by the ileum, the anterior incision can be made from the xiphoid to the pubic symphysis. If only one side needs to be replaced, an extended oblique oblique incision can be made to extend inward to the outer edge of the rectus abdominis. Then down to the pubic symphysis. 3. Intestinal tube selection: The main points are as follows: 1 The selected ileum segment must be 5 to 6 cm longer than the required ureter length. The exact length of the pseudo-small intestine can be calculated using the suture as a gauge. 2 The free intestinal segment must have good blood supply, and the mesenteric vascular arch width is sufficient. 3 The length of the intestine must be applied as short as possible to reduce the absorption of urine contents. The appropriate length required for most ureteral replacement procedures is 25 to 30 cm. After the upper end of the anastomosis is completed, the excess ileum should be removed before the lower end of the anastomosis. 4 The free intestine segment must be taken from the ileum more than 25 cm in front of the ileocecal valve. 5 The two ends of the cut ileum were anastomosed. After the mesentery was closed, the mucus and feces in the free intestinal segment were rinsed with physiological saline and 1% neomycin solution. The lower end of the free bowel segment is marked with two silk thread sutures to prevent the upper and lower ends from being reversed, which affects the peristaltic anastomosis. 4. Replace the ureter Replace the right ureter: Cut the posterior peritoneum on the outside of the cecum and ascending colon, and separate the ascending colon inward. The free ileum segment and its mesentery are passed through the opening of the ascending mesentery and placed in the retroperitoneal space. The ileum is rotated 90° counterclockwise to make it a creeping direction. Replace the left ureter: the posterior peritoneum of the descending colon and the outside of the sigmoid colon is incision, and the colon and mesentery are separated inward. A hole is made in the descending mesenteric membrane, and the free ileal segment is passed through the hole to enter the retroperitoneal space. In this case, there is no need to rotate the ileum, but care should be taken not to cause unnecessary tension of the mesentery due to too small a mesenteric opening. Replace the bilateral ureter: at the distance of 25cm from the ileocecal valve, the ileum is about 38 ~ 40cm, the upper end is closed, and the lower end is anastomosed to the bladder 3cm below the top of the bladder. The ureter was moved from the retroperitoneal posterior peritoneal incision to the peritoneal cavity and anastomosed to the ileum. 5. Ureteral (or renal pelvis) ileal segment anastomosis: close the upper end of the ileum segment, the upper end of the ureter is made elliptical. The intestine wall was cut in the upper part of the free ileum, and the caliber was as large as the section of the ureteral end, and the intestinal line was anastomosed with 4-0 chrome. When the renal pelvis is anastomosed to the upper end of the ileum segment, care must be taken not to damage the renal blood vessel supply. The upper end of the ileum segment is cut at the opposite side of the mesentery to make it suitable for the renal pelvis. The anastomosis was sutured continuously or intermittently with a 4-0 chrome gut. 6. The lower end of the ileum is anastomosed to the bladder: the anastomosis at the lower end is most convenient for the bladder. The posterior peritoneum of the bladder was separated, the anterior wall of the bladder was cut, and the posterior wall of the bladder was inserted from the outside to the inside with a finger at the appropriate site. The wall of the bladder was clamped with tissue forceps for circular resection, and the size of the ileum was required. The ends are adapted. The traction line at the lower end of the ileum is introduced into the bladder from the opening of the bladder, the length of the free ileum is adjusted, the excess is cut off, and the bleeding of the intestinal wall is properly stopped. The entire wall of the intestinal wall and the bladder wall were sutured intermittently with a 2-0 chrome gut. The sarcoplasmic layer is reinforced with silk sutures. 7. Drainage: The ureter is replaced by a ureter that is replaced by the bladder. The pelvis is drained from the ureter, and the tube is taken out from the lower end of the abdominal wall with the bladder fistula. 8. Stitching: Place the colon back in place, covering the ureter before the replacement. The free ileal segmental mesial is sutured with the posterior peritoneum to avoid the formation of internal hemorrhoids. The inner layer of the bladder wall was sutured with 2-0 chrome gut and the outer layer was sutured with silk. After the cigarettes were drained near the anastomosis, the incision was sutured layer by layer. complication High chlorine, high potassium.