SU1695895A1 - Method for plastic reconstruction of perviureteral segment - Google Patents

Abstract

This invention relates to medicine, specifically to pediatric urology, and is intended for the treatment of hydronephrosis in children. The goal is to improve the flow of urine from the kidney in the treatment of hydronephrosis in children. The pelvis is resected at an angle of the spine mow, corresponding to the age angle of inclination to the spine of the longitudinal axis of the kidney, and the angle is set aside, 0.5–1.0 cm from the edge of the renal lip, the ureter is obliquely cut, and the pelvic anastomosis is created -In the end. 1 tab.

Description

The invention relates to medicine, namely to pediatric urology, and is intended for the treatment of hydronephrosis in children.

The purpose of the invention is to improve the outflow of urine from the kidney in the treatment of hydronephrosis in children, which is achieved by taking into account the age angle of ureter discharge from the pelvis during its resection and the creation of an anastomosis.

The method is carried out as follows.

A tincture of brilliant green on the front surface of the pelvis is applied to the line connecting the medial surface of the kidney poles, parallel to the longitudinal axis of the kidney, from which the perpendicular p is restored through the middle of the pelvis. Departure by 0.5-1 cm from the place of intersection of these lines along the perpendicular line, mark the point through which the ureteral discharge angle from the pelvis is laid, corresponding to the age. The medial side of the corner is extended to the upper

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edge of the pelvis, according to which resection of the pelvis is performed. The ureter is crossed below the constriction site within healthy tissues. Dissect the lateral wall of the ureter for 1.5-2 cm. Anastomosis is imposed between the ureter and the pelvis, where the pelvic-ureteral angle corresponds to the age. The defect of the pelvis is sutured over the anastomosis.

Example 1. Yuli E., 1 year 3 months, was admitted to the hospital with a diagnosis of left-sided congenital hydronephrosis of the terminal stage, chronic obstructive pyelonephritis, relapsing course. The child performed plastic pelvic-ureteric segment of the proposed method. The left-sided paramedian access exposed the anterior surface of the kidney, the pelvis and the upper third of the ureter. The cause of hydronephrosis was stenosis in the area of the pelvic-ureteric segment. Lokhanka was located

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extrarenaline. On the front surface of the pelvis along the medial edge of the poles of the kidney held a brilliant green line, running parallel to the longitudinal axis of the kidney. To this line through the middle of the pelvis perpendicular p. Departure 1 cm from the place of intersection of these lines, marked the point through which the angle of resection of the pelvis, corresponding to 105 °. The pelvis was resected along the marked line. The ureter is crossed below the stenosis zone within healthy tissues. Dissected lateral ureteral wall over 2 cm.

 Imposed anastomosis between the ureter and the pelvis with the help of nodal catgut sutures. When applying the anastomosis produced nephrostomy through the middle cup. Peripephral space drained by a rubber graduate. Layer the stitches on the wound to drainage. The postoperative period was uneventful. The nephrostomy tube was removed on the 14th day, the wound healed by primary tension. The girl was discharged in a satisfactory condition on the 23rd day after the operation. The patient was examined after 6 months and 2 years. Blood and urine tests returned to normal within 1 month after discharge from the hospital. In the control urograms, there is a markedly positive dynamics compared with the data of the preoperative examination - the cup-pelvis system was significantly reduced, the thickness of the renal parenchyma increased, and the evacuation of the contrast agent by the newly created pelvic-ureter anastomosis is good. The common ureteral angle is 108 °

Example 2. Misha B., 13 years old, was admitted for examination for occasional abdominal pain, fever and leukocyturia. In the urograms on the right, a significant expansion of the collecting system of the kidney is noted, the renal parenchyma is thinned to 0.8-1.0 cm, and the kidney function is sharply reduced. On the left - no abnormalities. On the delayed urograms on the right (in 2-4 hours), the huge sizes of the calyx and pelvis are weakly contrasted. Ureter without contrasting Diagnosis:

right-sided congenital hydronephrosis, terminal stage. Surgery: Fedorov's right incision reveals the anterior surface of the kidney, the pelvis, the upper third of the ureter was isolated from cicatricial adhesions. The cause of hydronephrosis was a high discharge of the ureter from the pelvis. The patient underwent plastic surgery for the pelvic-buccal segment according to the proposed

way. The angle of resection of the pelvis was 120 °. The postoperative period was uneventful. The patient was examined after 6 months and 3 years. Urine tests returned to normal 2 months after

operations. Chronic obstructive pyelonephritis in the stage of persistent clinicol-borator remission. With excretory urography there is a significant reduction in the cup-pelvis-plating system.

on the right, the parenchyma of the right kidney is thickened to 2.2-2.5 cm. The function of the right kidney is good, the permeability in the area of the pelvieurological anastomosis is not impaired. Ureteropelvic angle is equal to

122 °.

Thus, the proposed method of plasty of the pelvic-ureteric segment improves the passage of urine from the cavities of the kidney to the underlying

the urinary tract due to the observance of the normal pelvic-ureteral angle. Comparison of the long-term results of treatment of children who underwent operations according to the known and proposed methods

confirms the advantages of the latter, as it allows to achieve a reduction in the progression of dystrophy of the renal parenchyma and improvement of the passage of urine from the kidney cavities (see Table 1).

Claims (1)

Invention Formula The method of plasty of the pelvic-ureteral segment, including resection of the pelvis and ureter with the creation of an anastomosis, characterized in that in order to improve the flow of urine from the kidney in the treatment of hydronephrosis in children, the pelvis resection is carried out at an angle to the axis of the spine, corresponding to the age angle of inclination of the longitudinal axis of the kidney to the spine, while the angle lay, indent from the edge of the renal lip 0.5-1.0 cm Indicators of RCTs and the time of delay in evacuation of a contrasting substance (KB) in children with hydronephrosis of 11-111 walls 2-5 years after surgical treatment