partial nephrectomy

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. Partial nephrectomy is often used in benign tumors or cysts of the kidney, local hydronephrosis or renal empyema, and renal tuberculosis. It is more commonly used in renal tuberculosis. Kidney tuberculosis achieves the goal of clearing the lesion and shortening the treatment time by surgery. 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. In recent years, the incidence of renal tuberculosis has increased and should be given enough attention. Best time: It is generally recommended to treat after the initial diagnosis of the disease. Special surgery should be prescribed. Postoperative recovery: postoperative recovery of good treatment of disease: hydronephrosis and renal tuberculosis Indication 1. Limited to one pole or one renal pelvis, and the renal pelvis's funnel tube is narrow, and it is impossible to discharge the kidney stones by itself. 2. Benign tumors or cysts of the kidney. 3. Local hydronephrosis or renal empyema. 4. Confined to a pole of renal tuberculosis, only after the use of anti-tuberculosis drugs for 1 to 2 years of ineffective, or when drug resistance or intolerance occurs during drug treatment, and when the lesion is changed to a closed state, the kidney part is considered. cut. Contraindications 1. One of the kidney tuberculosis lesions, has not been subjected to long-term, systematic anti-tuberculosis treatment. 2. The resected part of the solitary nephropathy is estimated to exceed 2/5 of the whole kidney, and the residual kidney part may not be able to maintain physiological needs, or those with no retention value. 3. Systemic disseminated tuberculosis is not controlled, and the general condition is poor. 4. The ipsilateral ureter or bladder has obvious tuberculous infiltrates. Preoperative preparation 1. The blood loss of this type of surgery can sometimes exceed the general nephrectomy, so the blood volume should be about 1000ml. 2. In recent years, the local renal cooling method is used to prolong the renal blood circulation blocking time. The operation time is extended from 30 minutes to 1-2 hours without causing renal parenchymal damage, which is conducive to complex surgery and avoiding ventricular fibers caused by systemic cooling. Sexual fibrillation and clotting mechanisms are disordered. When using this method, thousands of milliliters of physiological saline should be prepared before cooling to 0 to 7 °C. Surgical procedure 1. Exposure: Generally, the 11th intercostal exposure route is adopted. 2. Separate the kidney: exactly the same as nephrectomy. 3. Isolation and control of renal blood vessels: Carefully separate the adipose tissue at the renal hilum and expose the renal artery and renal vein. Use a heart-shaped pliers to gently clamp the renal pedicle blood vessels, preferably with a single clip of the renal artery to control bleeding. 4. Partial nephrectomy: 0.25% procaine was injected under the renal capsule to make the renal capsule bulge, then the renal capsule was cut transversely at the edge of the kidney and peeled off to the sides to reveal the plane to be resected. The diseased kidney is cut flat. In the renal pelvis, you can encounter a large time of blood vessels, and you need to use a mosquito-type hemostat to clamp and ligation. 5. Drainage and suture: After rinsing the renal pelvis, suture the rupture of the renal pelvis and renal pelvis with a common intestinal line. Cardiac ear clips that open the renal pedicle, if there is bleeding, should be clamped again, and the bleeding point will be sutured to stop bleeding. Sectional oozing can be stopped by hemostatic powder, gelatin sponge or patient's fat in the renal parenchyma section. After the heart-shaped pliers are removed and there is no active bleeding, the kidney capsules peeled off on both sides are overlapped and sutured on the kidney section. The kidney is returned to the original position, and the renal capsule is sutured with the nearby lumbar muscle for renal fixation to prevent renal torsion. Cigarette drainage is placed near the kidney section.