RU1835267C - Way of providing anastomosis in reconstructive ureter surgery - Google Patents

Description

shares of both narrowing and expansion. In addition, after ureterodilation, the implementation of the anastomosis does not present any technical difficulties.

To implement the proposed method for creating an anastomosis of the upper urinary tract, ureter ilatators are used, which are cone-shaped bougie, in the center of which there is a channel allowing local anesthetics to be introduced into the ureter lumen.

Example. Patient G., 36 years old, East. b-ni 1367 entered the clinic of urology 1 MMI named after I.M.Sechenova 12/13/89, with complaints of pain in the lumbar region on the left. Considers herself ill since January 1989, when dull, aching pain in the lumbar region first appeared. In March 1989, an excretory urography was performed, a stone was diagnosed in the middle third of the left ureter. With this examination, the patient is in satisfactory condition. The skin and visible mucous membranes of normal color. Vesicular breathing, no wheezing. Heart sounds are clear, rhythmic, no noise. Pulse 78 beats / min, blood pressure 120/80 mm Hg The lumbar region is not changed, the kidneys are not palpable, Pasternatsky's symptom on the right is negative, on the left is weakly positive. There is no dysuria.

In an X-ray examination, an overview of the organs of the urinary system determines a shadow measuring 0.7 x 0.8 cm in the projection of the left ureter at the level of the transverse process of the third lumbar vertebra, suspicious of calculus. In the series of excretory urograms, the right pelvic and pelvic system is not changed, the passage of the radiopaque substance is traced along the ureter to the bladder. To the left of the ureterohydronephrosis phenomenon, the calculus of the middle third of the ureter is determined, below which the passage of the radiopaque substance is not traced. Symptom Lichtenberg left positive.

On December 20, 89, the patient under anesthesia underwent thoracotomy in the XI intercostal space on the left, during which gross cicatricial changes in the ureter wall were detected at the site of the calculus 5 cm distal to the lower pole of the kidney. Above the calculus, the ureter is up to 1 cm in diameter, below it is 0.4-0.5 cm. Contractile movements of the ureter distal to the calculus are not visible.

Taking into account significant changes in the ureter wall around the stones, its resection was performed over 2.5 cm within healthy tissues, the ureteral funeral site along with the calculus was removed. The intersection of the ureter proximal and distal to the calculus is made in the oblique-transverse direction. Conical dilators No. 12 and No. 16 were inserted into the distal segment of the ureter; exposure after each injection was 5 minutes. The ureteral mucosa is 10.0 ml of 3% solution of trimecaine through the channel of the ureterodilator oro O After removal of the ureterodilator, the lumens of the distal and proximal ureters are the same. Formed ureteroureterinastomosis two U-shaped and

5 continuous upholstery seams. Drainage of the pyelocaliceal system of the left kidney was carried out by two polyvinyl chloride tubes.

The postoperative period was

0 without features. On the 8th day, antegrade pyeloureterography on the left was performed - the passage of the radiopaque substance is traced along the ureter to the bladder. Fragmented dilatation of the urine 5 of the ureter or of the pyelocaliceal system was not detected. There is no narrowing of the ureter at the site of the anastomosis. When pyelomanometry performed on the 10th day, the pressure in the pelvis does not exceed 13 mm century. For 15 days

0 after the operation, the nephrostomy tubes were removed, the urinary fistula in the lumbar region on the left closed independently after 10 hours. During the control ultrasound, dilatation of the pyelocaliceal system did not occur on the left.

5 On the 20th day, the patient in satisfactory condition was discharged for outpatient treatment.

During the follow-up examination after 2 months, the analysis of blood and urine is normal. On the

0 excretory urograms of the calyx-sucker- The night system on both sides is not changed, the passage of the radiopaque substance is traced to the bladder on both sides.

5 The positive effect of the proposed method compared with the prototype is that it is possible to reduce surgical trauma due to the fact that after ureterodilation in the joints is captured a small

0 the number of muscle elements of the ureter wall; increase the lumen of the anastomosis; maintain tissue viability, since the method allows to reduce the degree of ischemia of the ureter wall in the anastomotic zone,

5 to create optimal conditions for restoration of organ function and, therefore, to achieve a speedy recovery of the patient.

In addition, after such surgery, structural and functional changes are insignificant and there are no conditions for the occurrence of ureteral stenosis.

The above operation was performed by us in 32 patients. Postoperative x-ray, with television monitoring and video recording. An examination carried out in the next (15-20 days) and long-term (2-10 months) periods after surgery showed the absence of dilatation and adequate urodynamics of the upper urinary tract.

Timely normalization of urodynamics made it possible to achieve a stable disappearance of leukocyturia and bacteriuria and clinical recovery of the patient in the shortest possible time. We did not observe any complications when using the proposed method of operation.

Claims (1)

The method is simple and can be widely used in all urological departments where plastic surgery on the upper urinary tract is performed. For its implementation, a set of the ureterodilators described above is required. To reduce traumatic ™ and prevent anastomotic stenosis, after resection, the distal segment of the crossed ureter is dilated by insertion of a hollow bougie until the lumen of the distal ureter is the same proximal.