中文版09surgery of the kidneys light manuel jimenez譯解剖腎切開術(shù)切除術(shù)

Surgeryofthekidneys腎臟手Anatomy,nephrotomyandManuelJiménezDVMMRCVSDipl.Surgeryofthekidneys腎臟手Anatomy解剖Pyelotomy腎盂切開術(shù)Nephrotomy腎切開Nephroureterectomy腎輸尿管切除Surgicalkidneydiseases腎臟手Biopsies活組織檢查Calculiextraction取出Traumaticinjuries外傷 sia腫瘤Hydronephrosis,abscess,cysts,pseudocyst,urinoma...Surgicalkidneydiseases腎臟手Biopsies活組織檢查Calculiextraction取出Traumaticinjuries外傷 sia腫瘤Hydronephrosis,abscess,cysts,pseudocyst,urinoma...Anatomyofthekidney腎臟手

Anatomyofthekidney腎臟 角

動圓體Kidneybx腎臟活檢（適應(yīng)癥 sia腫瘤（？）NephroticsyndromesAKIRenalcorticalprotein-loosingKidneybx腎臟活檢 癥Coagulopathy凝血性疾病Hypertension高血壓RenalcystorabscessPyelonephritis++腎盂腎炎 lobstruction Hydronephrosis++腎盂積水++Interference(organsadhesionsetc.) Kidneybx(complications1-21%(needle=wedge1-21%（針=楔形刀）Thrombocytopenic血小板減少Prolongedclottingtimes凝血時間延長Creatinine>5mg/dL肌酐＞5mg/dL4years＞4<5 Kidneybx(complications腎臟活檢（并發(fā)癥Mayor9%:Severehaemorrhage,3%9%的主要并發(fā)癥：嚴(yán) 、Hypertension高血NSAIDslast5days至少使用5天HematuriaMacroscopic14%(24h)1-4%肉眼可見Microscopic2070%48-72h)20-70%顯微觀察（48-Perirenalhematomas10%dogs17%catsObstruction(clots),infarctions,Kidneybiopsy腎組織活檢（通路超聲引腹腔鏡Open開腹手wedgeIncisionalKidneybiopsy腎臟活Kidneybiopsy腎臟活Kidneybiopsy腎臟活Kidneylaparoscopic腹腔鏡下腎臟活Kidneylaparoscopic腹腔鏡下腎臟活Kidneylaparoscopic腹腔鏡下腎臟活Kidneylaparoscopic腹腔鏡下腎臟活Kidneywedgebiopsy腎臟楔形活Kidneywedgebiopsy腎臟楔形活NephrolithsCalciumoxalate草酸Treatmentif:需要治療Obstructionthatdecreaserenalfunction阻塞并減少腎Associatedtoseverehaematuria,pain,persistent涉及嚴(yán)重的血尿、疼痛、持續(xù)的泌尿系OrincreasinginsizedamagingrenaltissueNephrolithsLithotripsy,pyelolithotomy, Nephrolithsnotnecessarily=NephrectomyonlyindicatedPyelotomy腎盂切開Nephrolithinrenalpelvis腎盂Incisiondilatedrenalpelvis/proximalVertical/longitudinalincision橫向/縱向切口5-0or6-0absorbable5-0或6-0可吸收縫線Novascularocclusion無血管阻塞ReducesbloodlossPyelotomy腎盂切開Pyelotomy腎盂切開Pyelotomy腎盂切開Pyelotomy腎盂切開Pyelotomy腎盂切開Pyelotomy腎盂切開Pyelotomy腎盂切開Nephropexy腎固定Nephrotomy腎切開Bisectional(sharp)/intersegmental對半切開（銳性）/節(jié)段切開（鈍性NodifferenceinGFR腎小球?yàn)V過率無顯GFRincreasedby176%(4weeksafterRenalfunction?Inconsistent腎臟結(jié)30-50%decreaserenalfunctionNoadverseeffectonGFR(normalCats:normalGFRat12weeks術(shù)后12周腎小球?yàn)V過Nephrotomy腎切開術(shù)（適應(yīng)癥Chronicinfection PersistentPersistent(kidney持續(xù)（腎性Nephrotomy腎臟切開術(shù)（方法Nephrotomy腎臟切開術(shù)（方法Nephrotomy腎臟切開術(shù)（方法Nephrotomy腎臟切開術(shù)（方法Nephrotomy腎臟切開術(shù)（方法）GreaterreductionofNephrotomy腎臟切開術(shù)（方法腎輸尿管切除Irreparabletrauma不能修復(fù)的外Irreparabletrauma不能修復(fù)的外Persistent 腎輸尿管切除Irreparabletrauma不可修復(fù)的外Persistent Persistentinfection持續(xù) Persistenthydronephrosis持續(xù)性腎盂積水Renomegaly腎腫大Irreparabletrauma不可修復(fù)Persistentinfection持續(xù) Persistenthydronephrosis持續(xù)性腎盂積水Renomegaly腎腫大OtherRisksofleavingthekidneyinsitushouldbegreaterthantherisksassociatedwithremovingremovingEnsuretheremainingkidneywillbecapableofsustainingthepatient’slifeEnsuretheremainingkidneywillbecapableofsustainingthepatient’slife腎輸尿管切除腎輸尿管切除腎輸尿管切除腎輸尿管切除腎輸尿管切除腎輸尿管切除腎輸尿管切除腎輸尿管切除腎輸尿管切除腎輸尿管切除腎輸尿管切除腎輸尿管切除腎輸尿管切除腎輸尿管切除Nephroureterectomy腎輸尿管切除Renal siaCat:lymphoma(notsurgical貓：淋巴瘤（非手術(shù)Dogs:carcinoma(85%),TCC,TCP,as…CT/MRIandFNA CT/MRI及細(xì)針抽吸Abdominalmetastasis:腹部轉(zhuǎn)移Dogs54%(liver 犬：54%（肝、腎上腺Cats:36%(liver,adrenal, ,貓：36%（肝、腎上腺、腹膜、腸系膜MST 16m(carci),9m(sarco),6m(nephroblast).hemagiosarcSx+chemo:NoaffectonsurvivalinotherCourtesyDrLaurentCourtesyDrLaurentCourtesyDrLaurentCourtesyDrLaurentCourtesyDrLaurentCourtesyDrLaurentSurgeryofthekidneys腎臟手Surgeryofthekidneys腎臟手PyelotomybetterthanSurgeryofthekidneys腎臟手Pyelotom