isolated nephrolithotomy

Ota (1967) first successfully applied isolated kidney surgery for renal vascular hypertension. In 1974, Milsten et al began to treat staghorn kidney stones with autologous kidney transplantation. Chen Binglong et al reported in 1978 that renal incision and stone pelvis and renal pelvis were reported. Internal drainage for the treatment of staghorn kidney stones. Isolated renal incision stone removal is a combination of atrophic nephrolithotomy and autologous kidney transplantation. The advantages of this operation are: 1 The kidneys are well exposed, and any staghorn shaped stones and multiple stones with complicated shape and incarceration can be taken out. With the help of extracorporeal X-ray film, all the stones can be ensured. 2 The cooling is ideal, and the warm ischemia time is short. The application of cold ischemia technique can prolong the operation time. 3 The stone is taken in the bloodless surgical field, and the blood vessel section on the kidney cut surface is clear, which is convenient for sewing. 4 can treat other kidney diseases at the same time, such as correcting the stenosis of the renal pelvis neck or renal pelvic ureter junction, and relieve renal vascular hypertension. However, this procedure requires a high vascular anastomosis technique, the operation is more complicated, and renal angiography is required before surgery. There is still a certain failure rate in renal autograft transplantation, so its clinical application has certain limitations. Due to the further improvement of other in-body stone removal techniques, the scope of the indications for surgery has been significantly reduced. Treatment of diseases: kidney stones Indication 1. Multiple staghorn kidney stones that cannot be removed by orthotopic renal surgery, with good renal function and no serious infection. 2. Staghorn kidney stones combined with renal artery stenosis or renal aneurysms, renal vascular plastic surgery is required at the same time. Preoperative preparation 1. Adequate treatment of existing urinary tract infections, the application of broad-spectrum antibiotics should be strengthened 48 hours before surgery. 2. Prepare blood for 600ml. 3. Prepare local cooling supplies during surgery. 4. Preoperative renal artery-abdominal aortic angiography to understand the vascular condition. Surgical procedure The surgery included the following three operations: 1 nephrectomy. 2 no atrophic renal incision stone removal. 3 autologous kidney transplantation. The main steps are as follows: 1. Cut the kidney to take the 11th intercostal incision and extend down to the top of the pubic symphysis. Free the kidneys and reveal the blood vessels. After the blood vessels are ready, the kidneys are cut and placed on the bench. Note that the renal blood vessels should be as long as possible in order to match. 2. The low temperature treatment of the kidney is performed by a single hypothermia perfusion method. The compound balance solution or hypertonic citrate sputum (exclusive kidney preservation solution, referred to as HCA solution) is infused into the kidney to the venous reflux, and the kidney is cleared. It is grayish white, usually 300 to 400 ml. The perfusion pressure was 9.8 kPa (100 cm H2O). 3. No atrophic nephrolithotomy. The kidney was placed in an isolated kidney preservation solution at 0 to 4 ° C to maintain a low temperature, and the renal parenchyma, renal pelvis and renal pelvis were cut longitudinally along the plane of the relative avascular region. Remove the stones and examine the kidneys in vitro for X-ray examination to remove all stones. 4. Correct the renal pelvis funnel stenosis and cut the interval between two adjacent renal pelvis, and then suture the septum with a 4-0 absorbable line. Each two adjacent renal pelvis is fused into one large renal pelvis to relieve the stenosis of the renal pelvis. 5. suture the renal parenchyma incision with a large rounded needle to wear 2-0 absorbable line interrupted or sutured suture of the renal parenchyma, knotted to make the kidney cut surface close together, in order to make the renal parenchyma not split by suture, free adipose tissue or muscle can be used The tissue pad is tied under the suture and knotted, and the kidney capsule is sutured with a thin wire. After the kidney is sutured, the renal pedicle clip is removed. If there is still bleeding, it can be filled or pressed to stop bleeding. 6. Autologous kidney transplantation transplants the kidney to the ipsilateral armpit. The renal vein and the external iliac vein were anastomosed, and the renal artery and the internal iliac artery were anastomosed. 7. Close the incision layer by layer. 8. Renal artery remodeling is required if renal artery stenosis is combined. See ex vivo renal artery formation and autologous kidney transplantation.