tailieunhanh - UNDERSTANDING THE COMPLEXITIES OF KIDNEY TRANSPLANTATION Part 6

Ống thận thực chất cũng gồm 3 đoạn khác biệt nhau là ống lượn gần, quai Henle và ống lượn xa. Ống lượn gần và ống lượn xa nằm trong phần vỏ, quai Henle nằm trong phần tủy. | Augmentation Cystoplasty in Pretransplant Recepients 281 2. Augmentation cystoplasty using bowel segments enteroplasty General principles The initial approach to augmentation cystoplasty is similar regardless of the bowel segments to be used. Cystoscopy should be performed preoperatively to avoid any unsuspected anatomic abnormalities that may affect the surgery. In augmentation cystoplasty the two critical aspects of the surgery are the preparation of the bladder and the augmentation segment chosen. Preparation of the native bladder In augmentation cystoplasty the bladder usually is addressed first. Most commonly a midline incision is used to expose the abdomen pelvis. If possible the peritoneum is not entered until the bladder has been prepared for augmentation and other associated procedures such as ureteral reimplantation or bladder neck reconstruction have been performed. This minimizes third space fluid loss. The bladder is then bivalved through a sagittal incision from near the bladder neck anteriorly to near the trigone posteriorly thus forming a clam-shell configuration. This maneuver is extremely important because the bladder must be opened fully to prevent the augmentation segment from acting as a diverticulum with the formation of an hour-glass deformity. Such an incision allows a technically easier anastomosis of the bowel segment and leaves the native bladder wings to add to the overall capacity. The bladder wings may also be used for implantation of a continent catheterizable channel . Mitrofanoff or ureteral reimplantation. Supratrigonal cystectomy is generally not recommended. The remaining cuff of the bladder is a relatively small area for anastomosis to the intestinal segment therefore most of the bowel is approximated to itself which could result in the augmentation segment behaving as a diverticulum 1 15 . Nevertheless other surgeons have recommended that the majority of the diseased bladder be excised in preparation for .

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