ureterotomy

Ureteral calculi, combined with traditional Chinese and Western medicine treatment (such as taking stone soup, acupuncture and cystoscope intubation, ultrasonic lithotripsy or basket, or in vitro, under conditions of local shock wave lithotripsy) can be cured. Open cut stone removal is considered only when the above treatment is ineffective in order to protect kidney function, stop infection and relieve recurrent cramps. Treatment of diseases: ureteral stones and ureteral stones Indication 1. The ureteral calculi are larger than 1cm in diameter, or the surface is irregular and polygonal. 2. Stenosis of the urinary tract, or fixed stone position (severe multiple infections caused by local inflammation caused by heavy adhesions). 3. Ureteral calculi combined with infection is not effective, or combined with hydronephrosis is a serious threat to renal function. 4. Bilateral ureteral stone obstruction caused by urinary closure. Preoperative preparation Prepare blood for 600ml. Patients with urinary tract infections should be treated first, and surgery should be performed after infection control. Abdominal plain film should be taken before surgery on the day of surgery to finally determine the location of the stone and whether it has been excreted. Surgical procedure 1. Position: The position of the upper ureteral stone removal is the same as the nephrectomy. The middle and lower part of the stone is taken in the supine position, and the diseased side can be slightly elevated. 2. Exposing the ureter Expose the upper ureter: (1) Incision: The 12th rib tip is raised or slightly down, and down to the upper part of the anterior superior iliac spine. (2) Incision of the muscular layer: incision of the external oblique muscle, intra-abdominal oblique muscle and transverse abdominis muscle. When cutting the transverse abdominis muscle, take care to avoid damage to the subcostal nerves, blood vessels, the infraorbital nerves, and the inguinal nerves. (3) revealing the ureter: after entering the retroperitoneal space, it can be seen that the ureter is located in the posterior retroperitoneal psoas muscle, the spermatic vein, vein (or ovarian artery, vein) across the ureter should be protected to avoid injury. The middle ureter is revealed. (1) Incision: Two horizontal fingers above the midpoint of the upper iliac crest, and the oblique external oblique muscles to the outer half of the rectus abdominis. (2) Incision of the muscular layer: Incision of the external oblique muscle, intra-abdominal oblique muscle and transverse abdominis muscle into the retroperitoneal space. (3) revealing the ureter: the contents of the peritoneum and abdominal cavity are pulled inward, where the ureter is often associated with the peritoneal mucosa, which is easily pulled apart with the peritoneum and is not easy to find. The spermatic cord (ovary) blood vessels cross the axillary and vein on the outer lower side of the ureter. Expose the lower ureter: (1) Incision: about 2 cm inside the anterior superior iliac spine, and an arc-shaped incision to the midline of the abdomen, 1 cm above the pubic symphysis. (2) Incision of the muscular layer: the external oblique muscle is cut along the muscle line, the intra-abdominal oblique muscle and the transverse abdominis muscle are cut, and the combined tendon is cut transversely, and the anterior sheath of the rectus abdominis can be cut if necessary. After the muscle is incision, the lower abdominal wall can be seen in the lower corner of the incision, and damage should be avoided. If necessary, it can be ligated and cut off for surgery. (3) revealing the ureter: in the lower part of the ureter, women have uterine movements and veins. Men have vas deferens and spermatic tracts, and should be protected during separation. 3. Defining the stone site: Touching the finger along the ureter, you can often touch a hard mass that is bulging, which is where the stone is incarcerated. If it is not clear at the moment, the x-ray film should be referred to at any time, and then the tissue around the ureter is bluntly separated. 4. Cut the ureter and remove the stone: Pull the ureter with a gauze on the upper and lower ends of the stone to prevent the stone from slipping away. Place a gauze pad around the ureter to prevent pus or urine spillage when cutting the ureter. Then, the ureter at the stone is cut longitudinally, and the stone is removed with a curved hemostat or forceps. 5. Probe: Use the aspirator to absorb the spilled urine. Use a ureteral catheter to insert the ureteral incision up and down, up to the renal pelvis, down to the bladder, and explore the ureter with or without stones, stenosis or other causes of obstruction. 6. Suture the ureter: use a small curved needle to wear a 3-0 gut suture to suture the ureter 2 to 3 needles. The suture can only pass through the outer layer and the muscle layer without passing through the mucosa to prevent stones from recurring. Remove the protective gauze pad around the incision, cover the ureter suture around the adipose tissue, and fix the adipose tissue with 1 to 2 needles. If the inflammation of the ureteral calculi is heavier, a small incision should be made at the upper end of the ureteral incision. The ureteral catheter of 4 to 5 is inserted into the renal pelvis as drainage, and the original incision of the abdominal wall or another small incision is taken out. 7. Suture incision: After the wound was examined without bleeding and foreign matter remained, the cigarette was drained next to the ureteral incision. The operating table is leveled and the muscles, subcutaneous tissue and skin are sutured layer by layer.