treatment processing of a complication caused by us......pptVIP

Case report presentations: 27thOct ,2010 13:00am A ten-month-old child presents with the chief complaints of anuria for 48 hours. She also has a swollen face and eyelids。 Previous history and family history were negative accessory examinations ECG:sinus rhythm CT scan result: Ultrasound B: KUB:treatment processing of a complication caused by us......ppt In the meanwhile the child was given antibiotics,diuretics,Calcium Gluconate injection and Sodium biocarbonate injection But still no urine,so we decided to perform an emergent operation . 28th October,2010 01:00am A mini-invasive operation was performed ----- Put Double-J catheter under the ureteroscope Into both side ureter. 28th Octoer,2010 at 10:00am The amount of the urine:600ml the child had abdominal distension. KUB:The position of the left side Double pigtail stent was normal, But the right side was not normal. 28th Octoer,2010 at 15:30am we pulled out the left side Double pigtail sent under the uretroscope. ascitic fluid was draw out(60ml) by abdominal puncture. so, put a drainage into abdominal space. abdominal distension was gradually increasing, no better improvement on the childs condition . 29th Octoer,2010 at 10:30am ascitic fluid :300ml Urine:1450ml abdominal distension was gradually increasing, no better improvement on the childs condition . Renal made fistula 术后留置输尿管导管1～2天或双J管10 ～14天确保引流通畅 常见手术并发症 输尿管损伤（穿孔、撕脱） 尿外渗 感染 输尿管狭窄 输尿管损伤（穿孔、撕脱） 原因： 手术者的经验不足动作幅度较大或操作时间过长造成输尿管壁水肿嵌顿 各种因素导致的输尿管壁粘膜炎症水肿，脆性增加，弹性降低 结石较大、质地硬 麻醉不充分造成输尿管局部收缩和痉挛 预防与处理 预防措施： 正确选择适应症和治疗方式 避免盲目、暴力及勉强条件下进行手术 留置安全导丝 处理： 留置D-J管4至6周 输尿管完全离断时应及时改开放手术 尿 外 渗 原因：输尿管损伤 高压冲水 预防：防止输尿管损伤 发现穿孔视情况终止手术 处理：留置支架管 预防感染 感 染 原因：高压冲洗液体反流和外渗、手术时间长 输尿管引流不畅 预防： 术中控制灌洗液压力及手术时间 术后留置支架管 控制原发感染后再手术，脓肾先引流再碎石 合理应用抗菌素 输 尿 管 狭 窄 输尿管狭窄是输尿管损伤的远期并发症多发生在严重损伤和处理不当时。输尿管狭窄应按输尿管狭窄的治疗原则进行治疗 输尿管镜操作体