Intrarenal sinus pyelolithotomy

The renal sinus is called the renal sinus between the renal pelvis and the renal parenchyma. There is a layer of fat tissue separated by a kidney sinus fat pad. There is no large blood vessel in the gap between the renal sinus fat pad and the surface of the renal pelvis. It can enter the renal sinus between the surface of the renal pelvis and the fat pad and peel off the renal pelvis. It can even reveal the kidney sputum and does not cause serious bleeding. Incision of the renal pelvis in the renal sinus to remove the stone, said the renal sinus renal incision and stone removal. Treatment of diseases: hydronephrosis and kidney stones Indication 1. Kidney stones treated by combination of traditional Chinese and Western medicine are ineffective. 2. The stones are larger than 1cm or are staghorn stones, intrarenal pyelone stones, renal pelvis stones, and renal function is not reduced. Preoperative preparation 1. Those who have been infected with the urinary tract should be controlled with anti-infective drugs several days before surgery. 2. Take a plain x-ray film on the day before surgery to see if the position of the stone has changed or if the renal pelvis has been discharged. Surgical procedure 1. Exposing the renal pelvis: Since the renal blood vessels are traversed in front of the renal pelvis, in order to avoid damage, the renal pelvis is often revealed from the dorsal side. The upper part of the renal pelvis is called the renal sinus, which is separated from the renal parenchyma in the adipose tissue. This layer of adipose tissue is closely adhered to the renal parenchyma, with renal blood vessel branches and capillaries entering the renal parenchyma. There is a layer of connective tissue (the renal pelvic adventitia) between the adipose tissue layer and the renal pelvis wall. Separation under the outer membrane of the renal pelvis can avoid damage to the abundant small blood vessels in the adipose tissue and the posterior branch of the renal artery. At the same time, the junction of the renal pelvis and the ureter should be separated and lifted with a gauze strip to prevent small stones from squeezing into the ureter. 2. Incision of the renal pelvis: After all the pelvic pelvis is revealed, the posterior edge of the renal sinus (including the posterior renal pelvis) is pulled open with a blunt hook, and two traction wires are sewn in the appropriate part of the renal pelvis, and the surrounding is protected with gauze. Then cut longitudinally. 3. Take the stone: first use the little finger to reach into the sputum, explore the position of the stone, according to its different positions in the renal pelvis and renal pelvis, gently remove the stone with a stone cutter with different curvature. The rubber catheter was inserted into the renal pelvis through the incision and rinsed with saline. 4. Suture the renal pelvis incision: If there is no serious infection or continuous oozing, the ureteral incision can be sutured with a 3-0 chrome gut. The suture should not pass through the mucosal layer as much as possible to avoid the formation of foreign stone in the future. The fat around the renal pelvis is also sutured with several needles to cover the incision of the renal pelvis. If there is severe infection or oozing, the catheter can be drained through the renal pelvic incision. A cigarette was placed next to the incision of the renal pelvis and the incision was sutured layer by layer.