Nephrectomy

Surgical treatment of renal tuberculosis is to clear the lesion and shorten the treatment time. According to the extent of lesions, the extent of organ damage, renal tuberculosis, partial nephrectomy, nephrectomy, renal and ureteral resection, contralateral hydronephrosis surgery and surgical treatment of contracture bladder. In recent years, the incidence of renal tuberculosis has increased and should be given enough attention. Indication 1. Kidney malignancy. 2. Kidney tuberculosis One side of the kidney has been mostly or completely destroyed, the other side of the kidney is normal or the lesion is light, and the renal function is basically normal. After controlling for active tuberculosis in other areas, the damaged kidney can be removed. 3. Severe hydronephrosis or kidney stones, etc., the kidney has completely lost function, while the other side of the kidney is normal, the diseased kidney can be removed. 4. Severe kidney damage (such as kidney pedicle rupture or extensive kidney laceration, etc.). 5. One side of the pus kidney. Contraindications 1. Severe anemia, machine weight failure. 2. Severe damage to kidney function is not planned for allogeneic kidney transplantation. 3. Severe bleeding tendency. Preoperative preparation 1. Check the vital organs of the body, especially the renal function test (generally including urine routine, blood urea nitrogen determination and phenol red test), to determine whether the Jianbian kidney can compensate for urinary function. 2. Preoperative pyelography must be performed to determine the condition of the two kidneys. At the same time, it should be repeatedly verified where the diseased kidney is. Such as the newly discovered non-functional kidney of venous pyelography, although it can be caused by lesions, but it can also be caused by loss of contrast agent, or temporary renal artery spasm, should be identified. 3. Perform the necessary preoperative treatment. For example: kidney injury combined with shock, must be actively rescued, kidney tuberculosis should be treated before anti-tuberculosis treatment for a period of time (usually 2 weeks), urinary tract infection should be controlled, water and electrolyte disorders should be corrected, anemia and high blood pressure Should try to improve. Surgical procedure 1. Incision selection: The incision and exposure steps vary depending on the kidney site and the lesion, see the renal surgery exposure route. 2. Incision of the fascia around the kidney: After using various lumbar incisions to reach the fascia around the kidney, the posterior part of the kidney is separated, making a small incision, expanding up and down, taking care to avoid damage to the peritoneum. 3. Separate the kidney: Separate the fascia around the kidney with your fingers, starting from the convex and posterior sides of the kidney, then to the upper and lower poles and the front, and finally separating it to the renal pelvis along the upper segment of the ureter, separating it from the renal pedicle. 4. Dispose of the ureter: separate the ureteral lumbar segment, wrap it around the gauze strip, and lift it as far as possible. At the lowest point of the separation section, the ureter was clamped with two hemostats and cut between the two clamps. The two ends were disinfected with small cotton balls, pure carbolic acid, 75% alcohol and physiological saline. The distal end of the ureter is then ligated and sewed. 5. Treatment of renal blood vessels: Carefully separate the adipose tissue at the renal hilum to reveal the renal arteries and veins. The renal blood vessels are clamped with a three-reflection kidney tong or a large curved hemostat. Cut the blood vessels between the two clamps at the telecentric end and remove the diseased kidney. First ligature the proximal end of the blood vessel, take a lower forceps, and then make a suture at the distal end of the ligature. 6. Drainage and suture: After nephrectomy, the kidney fossa is blocked with warm saline gauze for a while, then carefully stop bleeding to remove residual diseased tissue. Place the cigarettes to drain and lead them out from the junction of the upper and middle sections of the incision. Then, remove the lumbar pad, put down the waist bridge, and suture the fascia around the kidney and the fascia of the lower back with silk. Finally, the latissimus dorsi, intra-abdominal oblique muscle, subcutaneous tissue and skin are sutured layer by layer.