Mob raum tsis ua hauj lwm: Yuav ua li cas Hloov Ureter Hernia ua rau Graft raum Hydronephrosis?
Mar 11, 2022
Yog xav paub ntxiv:ali.ma@wecistanche.com
Graft raum hydronephrosis tshwm sim los ntawm kev hloov ureter inguinal hernia Ib rooj plaub
Tian-you Chang, Chao-Hsiang Chang, Ping-Chin Lai, Wei-Ching Lin
1. Taw qhia
ureteralkev cuam tshuamyog ib qho teeb meem ntawmhloov raum. Txawm li cas los xij, ureteral obstruction tshwm sim los ntawminguinal herniayog ib qho teeb meem tsis tshua muaj, thiab muaj cov lus ceeb toom tsawg hauv cov ntaub ntawv. Cov laj thawj ntawminguinal herniation ntawm tus kab mob hloov pauvlub ureteryog redundancy ntawm covhloov pauvlub ureterthiab anterior positioning ntawm lub ureter nyob rau hauv relation mus rau spermatic qaum.P23I Txawm li cas los, cov mob no tsis tau pom nyob rau hauv peb tus neeg mob. Ntawm no, peb nthuav tawm ib rooj plaub tshwj xeeb ntawm allograft dysfunction, nyob qhov twghloov pauvlub ureteringuinal herniamuaj feem xyuam rau txoj hauj lwm tshwj xeeb ntawm graftraum.
2. Case report
Ib tug txiv neej muaj hnub nyoog 76- xyoo tau tuaj xyuas peb lub tsev kho mob nrog kev tsis txaus siab ntawm qhov o thiab indentation thaum nias ntawm ob txhais ceg rau 2 lub lis piam. Nws muaj keeb kwm kho mob yav dhau los ntawm ib lub nkoj coronary artery kab mob, lub pob zeb biliary tau dhau los ntawm endoscopic retrograde cholangiopancreatography, thiabkab mob raum kawgSecondary rau analgesic nephropathy. Nws tau dhau los ua neeg nyobraumhloov pauv3 xyoos dhau los hauv Suav teb loj.
Kev kuaj lub cev qhia tau tias muaj txoj cai sab xisinguinal herniathiab ob sab ceg qis qis qib 2/4 pitting edema. Nws cov qib creatinine hauv cov ntshav nce mus rau 1.2mg / dL (piv txwv li, 0.8mg / dL), thiab pw tsaug zoglub raumechography qhia graftraumhydronephrosis. Abdominal xam tomography tau ua, uas qhia tias mob hnyav hydroureteronephrosis ntawm tus kab mobraumallograft (Fig.1). External compression ntawm lubhloov pauvlub ureterlos ntawm txoj caiinguinal hernialhnab tau pom. Tsis tas li ntawd, lub raum grafted muaj qhov txawv txav, thiab lub hilum tau tig mus rau sab saud.
Lub graft artery thiab hlab ntsha ntsuas kwv yees li 6.5cm thiab 5.4cm nyob rau hauv ntev, feem. Percutaneous nephrostomy thiab antegrade pyelography tau ua tiav los txiav txim siab qhov tsis zoo hauvlub raummuaj nuj nqi(Fig.2). Qhov tsawg kawg nkaus ntawm qhov sib piv nruab nrab tuaj yeem ncav cuag lub zais zis. Qhov kev cuam tshuam yog nyob rau theem tam sim ntawd saum lub pubic symphysis. Ib ob-J raj (DJ) tau muab tso rau hauv qhov kev taw qhia antegrade, tom qab ntawd peb tau mus nrog kev tshawb nrhiav phais.
Los ntawm 7 cminguinalincision, lub spermatic qaum thiab ncaj-hom hernial sac raug txheeb xyuas. Raws li kev tso tawm ua ntej ntawm D, lub ureter tau txheeb xyuas thaum peb taug qab lub hernial sac mus rau nws lub caj dab, thiab qhov palpable hauv nws. (Fig.3) Adhesion tau pom ntawm lubhloov pauvlub ureterthiab hernial hnab. Tom qab adhesiolysis, siab ligation ntawm hernial sac yog ua los ntawm cov txheej txheem pursestring suture. Cov phab ntsa tom qab raug kho los ntawm cov txheej txheem McVay nrog kev cuam tshuam ntawm cov leeg sib txuas thiab Cooper lub ligament.
Foley catheter thiab DJ tau khaws cia rau 2 hnub thiab ib hlis 1, feem. Tom qab tshem tawm ntawm DJ, ua rawslub raumsonography qhia residualhydronephrosis. Txawm li cas los xij, qib creatinine hauv cov ntshav poob qis ntawm 1.2mg / dL rau 0.91mg / dL, thiab ob sab ceg qis pitting edema kuj ploj mus. Thaum 6 lub hlis ntawm kev soj ntsuam, tsis muaj cov tsos mob tshwm siminguinalherniathiab covlub raummuaj nuj nqinyob ruaj khov.
Sau ntawv tso cai tau txais los ntawm tus neeg mob rau kev tshaj tawm tsab ntawv ceeb toom no. Txij li txoj kev tshawb fawb no tsuas yog siv cov ntaub ntawv tus neeg mob tsis paub thiab luam tawm cov ntaub ntawv los ntawm cov ntaub ntawv, kev pom zoo los ntawm peb lub koom haum saib xyuas tsis tas yuav tsum muaj.
Daim duab 1. CT scan. (A) Lub raum hilum ntawm lub raum transplanted yog pom tig upwards.
(B) Lub ureter txuas mus rau superficially downwards ntawm / mus rau hauv lub zais zis; Txawm li cas los xij, yog compressed los ntawm hernial sac thiab yog li entrapped nyob rau hauv lubinguinaltus kwj dej. (C) Lub ureter yog compressed los ntawm lubinguinalhernia.
3. Kev sib tham
Muaj ntau yam ua rau graftraumhydronephrosis, nrog rau cov pob zeb ureteral, reflux, kab mob, thiab kev tsis lees paub.Inguinalherniationntawmhloov pauvlub ureteryog ib qho tsis tshua muaj ua rau ureteral obstruction nyob rau hauv cov ntaub ntawv ntawmraumhloov pauv.hloov pauvkws phais.
Daim duab 2. Antegrade pyelography.
(A) AP nthuav tawm ze-tag nrho cov kev cuam tshuam ntawmlub ureternyob rau theem ntawm superior margin ntawm pubic symphysis. (B) DJ yog muab tso rau hauv qhov kev taw qhia antegrade. AP=antegrade pyelography.
Tej yam uas yuav muaj feem yuav muaj xws li cov ureter redundant, [i] anterior positioning ntawm lub ureter nyob rau hauv relation to spermatic qaum [2,3land rog.17I Txawm li cas los, cov yam tseem ceeb no tsis nyob rau hauv peb cov ntaub ntawv. Hauv peb lub tswv yim, qhov teeb meem cuam tshuam nrog qhov txawv txav ntawm qhov graftraum. Nyob rau hauv peb cov ntaub ntawv, graftraumNws muaj cov hlab ntsha ntev heev (6.5cm) thiab cov hlab ntsha (5.4cm), vim tias lub hilum tig mus rau sab saud. Yog li ntawd, lub ureter nyob rau hauv superficially downwards thiab yog nquag musinguinalherniation.
Ultrasound yog thawj kab kev kuaj pom kev hloov pauv. Ultrasound feem ntau nthuav tawmhydronephrosis; Txawm li cas los xij, yuav tsis ua kom pom qhov pom ntawm qhov ntev ntawm lub ureter. xam tomography tuaj yeem muab cov ntaub ntawv qhia txog qib ntawm ureter obstruction thiab ureter entrapment nyob rau hauv lubinguinalhernia. ; txawm li cas los xij, kev tswj xyuas kev kho mob tsis hloov.
Hauv qhov xwm txheej tam sim no, DJ tau muab tso rau hauv qhov kev taw qhia antegrade preoperatively, uas ua rau muaj txiaj ntsig zoo rau kev txheeb xyuas cov ureter thaum lub sij hawm kev phais kev tshawb nrhiav.inguinaltus kwj dej. Nyob rau hauv peb cov ntaub ntawv, lub ureter twb nyob tob rau hauv lub posterior phab ntsa ntawm lubinguinalkwj dej thiab ze rau lub caj dab ntawm hernial sac. Rau peb txoj kev paub, qhov no yog ib qho ntawm ob peb txoj kev tshawb fawb kom muaj preoperative DJ insertion.17] Txawm hais tias feem ntau ntawm cov ntaub ntawv qhia txog cov ncauj lus no tsis muaj DJ tso ua ntej kev phais, tsis muaj ntaub ntawv hais txog lawv lub sijhawm ua haujlwm thiab kev pheej hmoo ntawm ureter. raug mob thaum phais kev tshawb nrhiav. Peb xav tias preoperative ureteral stent insertion tej zaum yuav yog ib qho kev xaiv zoo kom tsis txhob raug mob ureteral thaum lub sij hawm herniorrhaphy.hloov pauv lub ureteringuinalhernia.
Daim duab 3. Direct-type hernia pom nyob rau sab xis ntawm daim duab thiab ureter nrog DJ yog pom sab nraud rau hernial sac, nyob tob thiab ze rau nws lub caj dab.
4. Cov lus xaus
Hloovlub ureteringuinalherniayog ib yam mob uas tsis tshua muaj tshwm sim ua rau grafthydronephrosisthiab tom qab ntawdmob hnyavlub raumua tsis tiav. General kws phais thiab urologists yuav tsum xav txogureteralinguinalhernianyob rau hauv qhov sib txawv ntawm kev kuaj mob ntawm cov neeg mob uas muaj keeb kwm yav dhau los ntawmlub raumhloov pauv. Tsis tas li ntawd,hloov pauvCov kws phais yuav tsum nkag siab qhov tseem ceeb ntawm kev taw qhia ntawm lub raum graft. Txoj kev taw qhia tsis tsuas yog cuam tshuam rau cov hlab ntsha anastomosis tab sis kuj tseem cuam tshuam rau lub ureter rau compression los ntawm hernial sac.
Kev lees paub
Cov kws sau ntawv ua tsaug rau tus neeg mob thiab nws tsev neeg tau tso cai siv cov ntaub ntawv kho mob thiab lwm yam ntaub ntawv uas ua rau kev ua tiav ntawm tsab xov xwm tam sim no.
Cov ntaub ntawv
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