One of my personal interests is urologic surgery, that's part of one of the focuses of my surgical training.

我的個人興趣之一是泌尿外科，這也是我外科培訓的重點之一。

So I'm here to talk to you about subcutaneous ureteral bypass, or sub-surgery in cats.

所以，我在這裡和你們談談貓的皮下輸尿管旁路手術，或者說是皮下手術。

So the reason we do this, you may already know, is to help bypass an obstructed ureter.

你可能已經知道，我們之所以這樣做，是為了幫助繞過阻塞的輸尿管。

So when the kidney needs to empty urine into the bladder, if the ureter is blocked it cannot do that.

是以，當腎臟需要將尿液排入膀胱時，如果輸尿管堵塞，它就無法排尿。

So the sub is a way for us to bypass that blocked ureter and allow urine to empty from the kidney.

是以，潛水艇是我們繞過堵塞的輸尿管，讓尿液從腎臟排出的一種方式。

So we have a little diagram here of a cat's abdomen.

這裡有一張貓腹部的小圖。

The kidneys, there are two.

腎臟，有兩個。

Your cat may or may not have one or two of those ureters blocked, so the ureters are these white tubes running down through the abdomen into the bladder, which is this little circle here.

您的貓可能有一兩根輸尿管堵塞，也可能沒有，輸尿管就是這些白色管道，穿過腹部進入膀胱，也就是這個小圓圈。

So if those are blocked, if there is something blocking the way, typically a stone in cats, those are able to be bypassed by the use of our subcutaneous ureteral bypass system.

是以，如果輸尿管被堵塞，如果有東西擋住了去路，通常是貓體內的結石，就可以通過使用我們的皮下輸尿管旁路系統繞過輸尿管。

We have some of the implants here to help outline exactly what's involved, but in a very simple sense, we insert a tube into the pelvis part of the kidney.

我們在這裡展示了一些植入物，以幫助大家瞭解其中的具體內容，但從非常簡單的意義上講，我們將一根管子插入腎臟的骨盆部分。

So this down here is a transverse section of a kidney, so the brown outer parts here are what generate the urine as it is filtered from the blood, and it empties into this triangular section here, which is called the renal pelvis.

下面這個是腎臟的橫切面，褐色的外側部分從血液中過濾後產生尿液，尿液排入這個三角形部分，也就是腎盂。

So in most cases with ureteral bypass, the ureter and renal pelvis is more dilated than normal, which in terms of us placing these implants actually makes it more straightforward.

是以，在大多數輸尿管旁路手術的病例中，輸尿管和腎盂都會比正常情況下擴張得更厲害，這就使得我們在植入這些植入物時更加直接。

So what we need to do when we're placing that is insert a tube into this renal pelvis, which is then sealed with some glue on the outside.

是以，我們需要做的是將一根管子插入腎盂，然後在外面用膠水密封。

So here is one of the ureteral catheters.

這是其中一個輸尿管導管。

This is the end of the nephrostomy catheter, so the nephrostomy tube is the bit that goes into the kidney.

這是腎造瘻導管的末端，所以腎造瘻管就是進入腎臟的那部分。

So the important parts that we have at the end here, we have this curled J-shaped section with little fenestrations, little holes along the end, which allow urine to be passed through, and then the little string that you can see here at the end is also part of the locking loop.

在末端的重要部分，我們有一個捲曲的 "J "形部分，末端有小孔，可以讓尿液通過，然後你可以看到末端的小繩子也是鎖定環的一部分。

So you'll see if I pull on the string at the other end, that will hold that locked, which then allows this locked portion at the end to become less likely to then pull back out of the kidney.

所以你會看到，如果我拉動另一端的繩子，繩子就會被鎖住，這樣末端被鎖住的部分就不太可能從腎臟中拉出來。

So the last bit is this little cuff here, which is then super glued in place on the outside of the kidney, which helps form a seal around the edge of the hole that's passing through the tissue of the kidney to limit leakage.

最後一點就是這個小袖套，它被粘在腎臟外側，有助於在穿過腎臟組織的孔邊緣形成密封，從而限制滲漏。

Once we've placed this tube, it is then passed through the outside of the body wall, so this tube here ends up sitting at this end section here and curling around, and then it's passed outside the body wall, and that then allows us to connect one of these subcutaneous ports.

一旦我們放置了這根導管，它就會從體壁外側穿過，所以這根導管最終會坐在這裡的末端部分並捲曲，然後從體壁外側穿過，這樣我們就可以連接其中一個皮下端口。

So the port has three main parts.

是以，港口有三個主要部分。

So there is the nephrostomy connection tube and the cystostomy connection tube, so this is the end that goes to the kidney, comes from the kidney rather, and this is the end that then drains into the bladder.

這裡有腎造口術連接管和膀胱造口術連接管，這一端通向腎臟，來自腎臟，而這一端則排入膀胱。

This central portion here is a little silicon diaphragm, which allows us to pass a special needle called a Huber needle, which is designed not to cut any little cores out of the silicon diaphragm itself, so you can see it has a slightly bent end so that the tip of the needle doesn't cut a core through and leave a hole so it can leak, and that allows us to flush and drain the system and help avoid any further mineral collection, which can sometimes result in obstruction of the tubing.

這裡的中央部分是一個小硅隔膜，我們可以用它來穿過一個叫做 Huber 針的特殊針頭，這種針頭的設計不會從硅隔膜本身切出任何小芯，所以你可以看到它有一個稍微彎曲的末端，這樣針頭的尖端就不會切出一個芯，留下一個洞，這樣就可以洩漏了，這樣我們就可以沖洗和排空系統，有助於避免任何進一步的礦物質聚集，因為礦物質聚集有時會導致管道阻塞。

So that then gets sutured to the outside of the body wall after the tube from the kidney is connected to one end, and then a corresponding tube, so a second tube that is placed similarly to how it's placed into the kidney, doing the same thing, placed into the bladder to help then complete the circuit.

將腎臟的導管連接到一端後，將其縫合到體壁外，然後再將一根相應的導管，即與腎臟導管相似的第二根導管插入膀胱，以幫助完成迴路。

So it then gets connected to the other end of our subcutaneous port, and then connected through into the bladder.

然後將其連接到皮下接口的另一端，再通過接口連接到膀胱。

So instead of having this blocked ureter, the urine is able to flow through the tube that's inserted into the kidney, through this injection port which sits subcutaneously, and then that then follows through and drains into the bladder, thus bypassing the obstructed ureter.

這樣，尿液就不會堵塞輸尿管，而是能夠通過插入腎臟的管子，通過皮下的注射口流入腎臟，然後再通過腎臟排入膀胱，從而繞過阻塞的輸尿管。

So now the other benefit of having this subcutaneous port rather than just directly connecting the two, is that this injection port allows us to both easily collect urine samples and and also to flush the system, because the main reason for these problems happening is that these cats are prone to forming mineral stones, so those mineral stones can also form within the tubes themselves, so by regularly flushing them, it allows us to help control the, helps us control the likelihood of those blocking further down the track.

因為這些問題發生的主要原因是這些貓容易形成礦物質結石，所以這些礦物質結石也會在管道內形成，是以通過定期沖洗管道，可以幫助我們控制這些結石進一步堵塞的可能性。

When we're inserting these catheters, because the abdomen is open, we can visualise that they go into the kidney itself, but we still can't see the inside part of this, the end of this tube once it's been inserted, so, and although most of the cases have urine flowing back through the tube to confirm that it's in the right place, we also use fluoroscopy, which is video x-ray, to help identify the position by, after insertion of the tube, by injecting a contrast liquid into the tube itself, which then helps fill up the section of that renal pelvis, and helps both confirm the location, and the other thing it can do is help outline the size and diameter of the ureter further down, and typically also help locate the obstruction that's occurring as well.

當我們插入這些導管時，由於腹部是開放的，我們可以看到導管進入腎臟本身，但我們仍然無法看到導管的內部部分，也就是導管插入後的末端，是以，儘管大多數病例都有尿液通過導管迴流，以確認導管在正確的位置，但我們也會使用透視，也就是視頻X光、在插入輸尿管後，通過向輸尿管本身注入造影劑液體來幫助確定位置，這有助於填滿腎盂的部分，既有助於確認位置，也有助於進一步勾勒出輸尿管的大小和直徑，通常還有助於確定發生梗阻的位置。

So that typically allows us to be more confident that the nephrostomy portion of the catheter is exactly where we need it to be.

是以，這通常能讓我們更有把握地確定腎造瘻導管的位置。

And then once that's in place, we typically go about placing the rest of the bits which don't necessarily need fluoroscopy, but the other thing we do at the end of surgery, once everything is in place, is we'll inject some contrast into the subcutaneous port, which helps confirm the patency of all of the tubing, to make sure that both liquid can flow back and forth into the kidney, but also back and forth into the bladder as well, to help us ensure that the system is doing what it needs to do.

手術結束後，一旦一切就緒，我們會在皮下端口注射一些造影劑，這有助於確認所有管道的通暢性，確保液體可以來回流入腎臟，同時也可以來回流入膀胱，幫助我們確保系統完成其需要做的事情。

So thanks very much for listening to our video about placement and the use of subcutaneous ureteral bypass, so if you do have any questions, please feel free to get in contact with us at veterinary specialist services, and cat specialist services, and we'll be very happy to try and answer any questions you have.

如果您有任何問題，請隨時聯繫我們的獸醫專家服務部和貓科專家服務部，我們將非常樂意回答您的任何問題。

Thank you.

謝謝。