RU1771700C - Method of urinary bladder autoplasty - Google Patents

Abstract

The invention relates to medicine, namely to surgery, and can be used in surgical interventions on the bladder to remove a tumor that grows on the posterior wall of the bladder, covering its peritoneum and the back of the base of the bladder. The goal is to reduce the incidence of postoperative complications by maintaining the capacity of the organ. The latter is dissected in the front, back, down direction, starting the incision at the borders of the side walls from the front and continuing it by 5-7 cm towards the base of the bubble, without cutting the base, the selected flaps are turned to each other with proximal ends to the medial side and stitched together and the base of the bubble, and the apex and front wall are formed due to the muscles of the anterior abdominal wall and peritoneum. Using the developed autoplasty method allows avoiding the appearance of intestinal vesiculitis, achieving restoration of the function of the upper urinary tract and normal volume of the urinary bladder.

Description

The invention relates to medicine, namely to surgery, and can be used in surgical interventions on the bladder to remove a tumor that grows on the posterior wall of the bladder, covering its peritoneum and the back of the base of the bladder.

A known method of operations on the bladder for a neoplasm when the cancer is located near the mouth of the ureters or they are involved in a blastomatous process in which a subtotal resection of the bladder or hemicystectomy is performed, a defect in the bladder wall formed after resection is sutured with two-row knotted catgut sutures

A disadvantage of the known method is a decrease in bladder capacity,

cross-linking of the bladder near the mouth of the ureters leads to cicatricial stenosis of the latter, and the use of an unopened sigmoid colon to create a bladder defect is fraught with the formation of intestinal fistulas.

The aim of the invention is to reduce the incidence of postoperative complications due to the preservation of the capacity of the organ, which is achieved by the formation of the posterior wall from the side walls of the organ, for which an incision is made 5-7 cm long towards the base, without cutting it, in the front, back, down direction , the selected flaps are turned to each other with proximal ends in the medial direction, stitched together with each other and the base of the bladder, and its top and front wall are formed behind

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muscle count of the anterior abdominal wall and peritoneum.

The method is carried out as follows.

After intubation of the patient via abdominal access, the posterior wall is resected with the peritoneal and posterior parts of the base of the bladder covering it and the tumor located in this part, then 5-7 cm incisions are made towards the base at the borders of the side walls and the anterior bladder, without it dissection in the front to back and down direction, the selected flaps are rotated to each other with proximal ends in the medial side and the bubble is sewn together and the base, and the apex and front wall are formed due to the front trouser hydrochloric wall and peritoneum.

An example of a specific embodiment of the method.

Patient B., 57 years old. medical history N 1578 / G, entered the urology department of the Rostov Cancer Research Institute with a diagnosis of bladder cancer.

On October 14, 1985, an operation was performed - la-parotomy, resection of a part of the base of the bladder and apex, plastic of the bladder.

After opening the abdominal cavity and cystotomy, an infiltrative tumor of 5x5 cm was found, occupying the base of the bladder 4 cm above the ureter ligament and passing to the apex. The tumor sprouts a transitional sheet of the peritoneum. The peritoneum covering the bladder is dissected by two bordering incisions around the infiltration site. The bladder is extraperitonized. Indent from the tumor on

3 cm, resection of the base of the bladder and part of the apex. 5-7 cm lateral walls were cut towards the base without being cut in the front, back and down directions; the selected flaps are turned to each other with proximal ends in the medial direction and are stitched between themselves and the base of the bladder. The apex and anterior wall are formed by the anterior abdominal wall and peritoneum.

The immediate postoperative period was uneventful. On the twentieth day, urination recovered.

November 26, 85 g, the patient was discharged in satisfactory condition with self-urination.

During the follow-up examination after 3 months, the bladder capacity was 170 ml; in the urogram, the kidney function was not impaired.

Claims (1)

SUMMARY OF THE INVENTION A method for autoplasty of the bladder, comprising transperitoneal access and resection of its posterior wall, characterized in that, in order to reduce the frequency of postoperative complications by maintaining the capacity of the organ, the posterior wall is formed from the side walls of the organ, for which the bladder is dissected at the borders side walls from the front in the direction from front to back and down towards the base by 5-7 cm, the selected flaps are turned medially to each other by proximal edges, which are stitched together with each other and the base bladder, and the defect formed at the top and front wall of the bladder around the perimeter is fixed to the rear surface of the anterior abdominal wall.