RU2187257C2 - Method for forming the bladder - Google Patents

Abstract

FIELD: medicine, surgery, oncology. SUBSTANCE: bladder tumor and sigmoid flexure tumor are removed together. A sigmorectal anastomosis is applied. Remained bladder edges are sutured to pubic bones' periosteum and muscular elements of pelvic walls. It is formed a posterior wall and a bottom of the bladder due to the loop of ileum and its mesentery. Extraperitonization of intestinal anastomosis is performed with the residues of pelvic peritoneum and the greater omentum by developing an anterior bladder wall due to the muscles of anterior abdominal wall. The method enables to keep the natural function of urination. EFFECT: higher efficiency of operation. 1 dwg

Description

 The invention relates to medicine, more specifically to surgical methods for the treatment of malignant tumors, and can be used in operations for excision of a part of the colon affected by a tumor that grows in the bladder and requires removal of its part.

 There is a method of removing malignant lesions of the bladder or tumor that grows into it from neighboring organs, when, depending on the affected area, either a bladder is resected leaving the prostate and seminal vesicles, or it is resected with part of the prostate and seminal vesicles (according to Frumkin A.P., in the description of Pogozheva L.P.), (Chukhrienko A.P., Lyulko A.V., "Atlas of operations on the organs of the urinary system", M., "Medicine", 1972).

 The operation proposed by the authors to remove a malignant lesion of the bladder makes it possible to excise the lesion, stitch the remaining parts of the bladder, saving the patient from a malignant tumor.

 However, operations of this kind, simultaneously with positive features, have negative ones, since they significantly reduce the bladder. The principles of surgical interventions often require resection of one of the ureters and, as a result, lead to difficulties in removing urine from the kidneys. A decrease in the volume of the bladder, a violation of the natural function of urination, which occurs often and involuntarily, leads the patient who underwent surgery of this kind to disability, a significant deterioration in the quality of life.

 A known method of removing a malignant lesion of the bladder when, after excision, the vesicle is formed from a flap of the peritoneum.

 In the process of bladder resection, a flap is cut out of the pelvic peritoneum, the posterior wall of the bladder is formed by stitching the remaining part of the bladder with the peritoneum with a double-row immersion seam; The ureter with the preformed cuff is intubated with silicone drainage and transplanted into the remainder of the bladder. Then an endoprosthesis is placed in the post-resection cavity (a polyethylene tube on which a double rubber balloon is fixed), which is wrapped with a peritoneal flap and sutured to the remaining part of the bladder. After resection, the endoprosthesis is filled with a solution of furatsilina to the required volume. On the 10-11 day after surgery, the endoprosthesis is removed. To exclude possible urinary leakage, the free part of the bladder is fixed to the peritoneum and muscles of the anterior abdominal wall (certificate of authorship 554859 of 04.25.77, Bulletin 15 and supplementary certificate of authorship 663391 of 05.20.79, bulletin 19).

 The described method for creating and restoring the volume of the bladder significantly expanded the arsenal of possibilities for the surgical treatment of malignant lesions of the bladder.

 However, when a malignant lesion of the bladder occurs from a nearby organ or part of it, the colon, vitally necessary removal of a malignant tumor of the intestine is necessary. Conducting a known method of removing a tumor of the bladder and restoring its volume is not possible. After removal of a similar bladder tumor, a large post-resection defect is formed both in the intestinal region and in the bladder. There are so few proper tissues of the bladder that it is not possible to count on their stretching and restoration of the natural function of urination.

 The aim of the invention is to preserve the natural function of urination and the possibility of increasing the volume of the bladder.

 This goal is achieved by the fact that after removal of the colon tumor, excision of the affected sprouted part of the bladder, the bladder is formed (drawing) by suturing its edges along the anterior semicircle 1 to the periosteum of the pubic bones 2 and the muscle elements of the pelvic walls, the posterior wall and the bottom of the bladder - from an unopened loop of the ileum 3 and its mesentery 4, the anterior wall are the muscles of the anterior abdominal wall; the newly formed bladder is separated by extraperitonization of the intestinal anastomosis with the remains of the pelvic peritoneum and a large omentum.

 A comparative analysis of the presented "Method for the formation of the bladder" with known methods of surgical interventions and the formation of the bladder gives reason to talk about the novelty of the developed method, which is represented by the use of autotissues of the ileum, peritoneum, which does not lead to tissue rejection, inflammatory processes, and decay of the formed bladder.

 Unlike the prototype, the “Method” does not involve the use of any endoprostheses, which does not aggravate the patient’s condition from the first moments after the operation.

 The developed method has an inventive step, as it obviously does not follow for a specialist oncourologist from a known level of development of medicine. In well-known sources of information in Russia, the CIS countries and abroad, indications of a similar method were not found.

 The invention is industrially applicable, as it can be reproduced if necessary, prompt removal of a colon tumor with germination in the bladder in surgical or oncourological hospitals of medical institutions.

 An example of a specific application of the "Method" can serve as an extract from the medical history.

 Patient I., born in 1930, case history 6045 was admitted to the oncology department of the Krasnodar Territory Clinical Oncology Center on March 16, 1996 with complaints of dysuric phenomena (urination after 30-40 minutes), pain in the lower abdomen, constipation (stool only with an enema) , an admixture of blood, mucus in the feces. Sick for six months. The examination revealed cancer of the sigmoid colon: T4, N0, M0, G2, P4 with invasion of the bladder. 04/01/96, an operation was performed - a combined sigmioidectomy with subtotal resection of the bladder. When laparotomy revealed a large tumor of the sigmoid colon fixed to the bladder. Prior to the audit, an impression was made of a total lesion of the bladder. The operation was started from the bladder. After revision of the latter, it was revealed that the tumor affects the body and the apex of the bladder. Subtotal resection of the bladder-affected part of the bladder was performed in a single block with the sigmoid colon. Intestinal continuity is restored by applying end-to-end sigmorectal anastomosis. Then the bladder was formed by suturing the remaining edges along the anterior semicircle to the periosteum of the pubic bones and the muscular elements of the pelvic walls, the posterior wall and the bottom of the bladder are made of an unopened loop of the ileum and its mesentery, the anterior wall is formed by the muscles of the anterior abdominal wall. The formed bladder is divided by extraperitonization of the intestinal anastomosis with the remains of the pelvic peritoneum and a large omentum. The area of the anastomosis is drained by two double-lumen drainages installed through paranal conraappertures. Also installed drainage in the pelvis and left flank, microirrigator for the introduction of antibiotics into the epigastrium. The wound is sutured.

 The postoperative period was uneventful, without complications. Leakage of urine beyond the boundaries of the formed bladder was not observed.

 Bladder training started on the 15th day after surgery. On the 21st day, independent urination was restored.

 When 3 months later, the patient is active. There are no complaints from the kidneys or the bladder. Urination is independent. At the next dispensary examination after 6 months: the capacity of the bladder is 150-180 ml, urination after 2-3 hours in the daytime, at night 2-3 times per night.

 At the control examination in 1999, the patient's condition is satisfactory, there are no signs of disease recurrence.

The technical and economic effectiveness of the proposed "Method for the formation of the bladder" consists in the possibility:
- perform a radical removal of the formation growing in the bladder;
- avoid cystectomy, restore the volume and natural function of the resected bladder;
- social and labor rehabilitation of operated patients, improving their quality of life.

Claims (1)

 A method of forming a bladder, including removing a tumor of the bladder and sigmoid colon in a single block, restoring intestinal continuity by applying a sigmorectal anastomosis, suturing the remaining edges of the bladder to the periosteum of the pubic bones and muscle elements of the walls of the pelvis, forming the posterior wall and the bottom of the bladder from the unopened loop and its mesentery, extraperitonization of the intestinal anastomosis with the remains of the pelvic peritoneum and a large omentum with the formation of the anterior wall of the bladder muscles of the anterior abdominal wall.