Ligation of renal pedicle lymphatic vessels, intraspermatic (ovarian) vein anastomosis of renal pedicle lymphatic vessels

Chyluria is a complication of filariasis, and most people believe that chylomicrons are caused by adult filariasis or lesions caused by obstruction or motility of the thoracic duct. Intrarenal lymphatic vessels are mainly distributed in the interlobular space and around the glomerulus. Intrarenal venous pressure and elevated renal pelvic pressure can accelerate renal lymphatic reflux. When lymphatic reflux is blocked, the pressure will increase and the lymphatic vessels will burst and lymph fluid will flow into the kidneys. Chyluria. The disease has the possibility of self-healing. It can usually be cured by diet regulation, Chinese herbal medicine and renal pelvic lavage therapy. Only a few patients need surgery. Treatment of diseases: filariasis chronic pyelonephritis Indication Chyluria has not healed for a long time, non-surgical treatment is ineffective, symptoms are severe, chyle blocks cause dysuria, or persistent chyle hematuria, resulting in malnutrition and anemia, seriously affecting workers. Preoperative preparation 1. Before surgery, cystoscopy should be performed to confirm that chyluria is ejected from one or both sides of the ureteral orifice, to determine which side of the kidney from which the chyluria is coming from, in order to determine the side of the operation, or to perform lymphatic angiography to confirm which side of the pedicle Lymphatic varices. 2. Patients with urinary tract infections should be treated with antibiotics. Surgical procedure 1. Position: lateral position. 2. Incision, exposure: The kidney was separated by the 11th intercostal incision, the renal pedicle was fully exposed, and the lymphatic vessels of the renal pedicle were examined for expansion, and there was no lymphedema around the renal pedicle. Then, 1 ml of 0.5% Evans Blue was injected into the tissue surrounding the renal pedicle, and after 5 minutes, the renal pedicle lymphatics were displayed. 3. Isolation, ligation and cutting of the renal pedicle lymphatic vessels: The lymphatic vessels and loose tissues of the renal pedicle are separated from the renal artery, the vein, and the veins and veins by bending or right angle hemostats, respectively, and then cut off after ligation to make the renal pelvis and the upper end of the ureter Separated from the surrounding loose tissue. 4. Divide a thicker renal pedicle lymphatic: Check carefully in the vicinity of the spermatic cord (ovary). If you can find a large lymphatic tube, you can separate and cut it. The proximal end of the chyle solution was temporarily clamped with a small blood vessel clamp to prepare an anastomosis. The distal end is ligated with a silk thread. 5. Isolation of the spermatic cord (ovarian) vein: The vein was isolated and the vein was severed 6 to 8 cm from the inferior vena cava (right) or renal vein (left) entrance. Use a small blood vessel clip to temporarily clamp the proximal end, and remove the venous rupture of the outer membrane, and wash the lumen with saline (be careful not to damage the intima). The distal end vein is ligated. 6. Lymphatic vessels and spermatic cord (ovarian) vein end-to-end anastomosis: the proximal end of the thick lymphatic vessel to be anastomosed and the proximal end of the vein are firstly towed with a 7-0 nylon thread, then the needle is interrupted. Stitch to make the anastomosis edge eversion. Before ligation of the last suture, the small vessel clamp at the end of the lymphatic vessel should be opened to expel the air in the lumen to prevent the airway. After ligation, if the anastomosis is smooth, the lymph fluid can be seen to flow into the spermatic cord (ovary) vein through the anastomosis. 7. Fix the kidney: suture the suture with the 3-0 chrome gut in the infrarenal and dorsal capsules, and suture the suture to the deep side of the psoas muscle. The fascia around the kidney was sutured, and cigarettes were drained around the kidney.