Nephrolithotomy

1. Stones that are too large or staghorn in the renal pelvis cannot be removed through the incision of the renal pelvis. 2. The stone is small and the position in the renal pelvis is not certain. Treatment of diseases: kidney stones and ureteral stones Indication 1. Stones that are too large or staghorn in the renal pelvis cannot be removed through the incision of the renal pelvis. 2. The stone is small and the position in the renal pelvis is not certain. Preoperative preparation Prepare blood for 600ml. Patients with urinary tract infections should be treated first, and surgery should be performed after infection control. Surgical procedure (1) Separation of the renal pelvis and kidney 1. Incision: Enter through the 12th ribbed exposure pathway to separate the upper part of the kidney and ureter. 2. Renal pelvis, kidney incision exploration: two incisions in the kidney, one in the renal pelvis, one in the renal cortex. The pelvic incision is used for finger exploration of stones. When the incision of the renal cortex is large, the kidney is locally cooled, and then the rubber tube is blocked with a heart ear pliers or a curved clamp to block the blood supply of the kidney, and the blood loss during the operation is reduced (the blocking time should not exceed 30 minutes). Before cutting the renal parenchyma, the needle should be inserted into the stone. When the stone is touched, the needle is kept and cut along the needle with a sharp edged knife. 3. Pushing the stone: Insert the finger through the incision of the renal pelvis, and after the exact examination, the stone in the renal pelvis will be gently pushed out through the renal parenchyma. 4. Take the stone: through the renal cortex incision into the stone pliers, under the joint operation of the finger in the renal pelvis, after clamping the stone, gently turn in the appropriate direction and pull out. If the stone is staghorn-shaped, the branch protrudes into the renal pelvis, and the funnel can be gently pulled away by a shank or a hard stripper to help remove the stone. 5. Rinse the renal pelvis: After removing the stone, rinse the renal pelvis with normal saline and flush out the residual small stones. 6. Hemostasis: The arcuate vessels at the junction of the renal pelvis, renal cortex and renal medulla were sewed with a 4-0 gut. 7. Suture the renal pelvis and renal pelvis: use the 4-0 gut through the incision of the renal cortex to suture the deep incision of the renal pelvis and renal pelvis, so that the renal incision and the renal pelvis are separated to avoid postoperative renal parenchymal hemorrhage. Flow into the renal pelvis, causing clot obstruction and other after-effects. 8. Loosen the kidney pedicle ear clip: hold the kidney cortex incision with your left hand, and gradually loosen the heart ampule of the kidney pedicle with your right hand to observe whether the hemostasis is perfect. If there is less bleeding, you can use the warm saline gauze to stop the bleeding. 9. suture the renal cortex: use the gut line to suture the renal parenchyma before and after the pelvis, generally three stitches can be used, not too much (or 2 to 3 stitches for suture), then suture the suture one by one to make the kidney cut Face the face, and then suture the renal capsule with a 3-0 gut. If the renal capsule is defective, free adipose tissue may be used to cover the surface of the kidney, and then the suture penetrating through the renal parenchyma may be ligated. 10. Suture the renal pelvis: Before suturing the renal pelvis, insert the catheter through the incision of the renal pelvis for flushing; if there is a small amount of bleeding in the renal pelvis, rinse with iced saline to stop bleeding. After rinsing, the renal pelvis was sutured intermittently with a 2-0 to 3-0 gut. 11. Suture incision: the perforated renal rubber tube and cigarette drainage, suture the lumbar incision. (B) renal pelvis, kidney combined with open stone removal 1. Incision of the renal parenchyma: If the stone cannot be removed after the incision of the renal pelvis, the renal pedicle is gently clipped with a renal pedicle (or heart-shaped pliers) after local cooling, and then the renal pelvis incision is extended to the renal parenchyma in a "u" shape. . 2. Take the stone and rinse: After removing the stone from the incision, rinse the renal pelvis and completely rush the stone fragments. 3. Hemostasis and suture: After loosening the renal pedicle, observe whether there is bleeding. If there is bleeding, the renal pedicle should be clamped again, and the bleeding point is sutured with a small intestine. Then release the renal pedicle clamp. If there is no bleeding, the renal pelvis should be washed to remove the blood clot. The renal parenchyma incision is sutured with a thin intestine and is usually not required for pyelolithoplasty. After observing no bleeding, the renal pelvis incision was sutured with a thin intestinal line.