RU2256409C2 - Method for transplanting ureter into intestine - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves cutting out elliptic flap from urinary bladder wall around intravesical part of ureteral orifice. The greater diameter corresponds to distance between ureteral and urethral orifices 2-3 mm laterally far from them. The lesser diameter is determined in individual way depending on anatomical structure of urinary bladder triangle and bladder tumor injury degree, but not less than 1 cm.

EFFECT: retained urethral and ureteral muscular contracture apparatus; higher life quality; improved long-term treatment results.

Description

The invention relates to medicine, namely to surgery, and can be applied in the formation of an artificial bladder after cystectomy for locally advanced cancer of the rectum and female genitalia.

A known method of closed ureterosigmoanastomosis, in which the ureter is isolated before adventitia, is crossed at the bladder, is transplanted into the intestine (F. Hinman / Operational urology. Atlas. - Moscow. - 2001. - S.374-376).

The above method has a significant drawback: it does not allow to maintain the natural closure apparatus at the level of the vesicoureteral and vesicourethral segments.

As a prototype, we chose a method for transplanting a urinary bubble into a semi-insulated segment of the sigmoid colon (N.V. Klyuka / Abstract for the degree of candidate of medical sciences. Rostov-on-Don. 2003. 24 S.).

The method has the following disadvantage: it is not applicable for locally advanced cancer of the colon and female genitalia, when the tumor spreads to the urinary bubble.

The aim of the present invention is to develop a reliable method for transplanting part of the urinary bladder triangle into an artificial bladder while preserving the natural closure apparatus of the ureter and urethra.

This goal is achieved by the fact that when the ureter and urethra are separated in the region of the urinary bladder triangle around their holes, an ellipsoid flap is cut out from the wall of the bladder, the larger diameter of which corresponds to the distance between these holes and departing from them laterally by 2-3 mm, the smaller is determined individually in depending on the anatomical structure of the urinary bubble triangle and the degree of damage to the bladder by a tumor, but not less than 1 cm.

The invention “A method for transplanting the ureter into the intestine" is new, as it is unknown in medicine and in surgery in particular.

The novelty lies in the fact that a specially cut out part of the urinary bladder is transplanted into an artificial bladder.

In available sources of information in Russia, the CIS countries and abroad, a similar method is absent.

The invention “A method for transplanting the ureter into the intestine” is industrially applicable, as it can be used in the surgical treatment of locally advanced colon cancers and female genitalia in oncological institutions.

The method was carried out as follows.

During the mobilization of the drug during evisceration, a cystotomy was performed, and the region of the urinary bladder triangle was revised. In the event that the mouth of one of the ureters and the urethral opening were intact, a flap in the shape of an ellipse was cut out from the urinary bubble triangle, the larger diameter of which corresponded to the distance between the ureter and urethral openings and departing from them laterally by 2-3 mm, the smaller one was determined individually depending from the anatomical structure of the bladder triangle and the degree of lesion of the bladder by a tumor, but not less than 1 cm. The mucous and muscle membranes of the bladder wall were dissected along the perimeter of the intended flap, the cut flap was wrapped in a napkin moistened with a 0.5% solution of chloramine. At the reconstructive stage, a flap was sutured into the urinary reservoir.

Example.

Patient P., 56 years old, was admitted to the TAO RNII with a diagnosis of colorectal cancer, clinical group 2. Taking into account complaints of periodic staining of urine with blood, the patient underwent cystoscopy. It was found that on the posterior wall of the bladder to the left of the midline there is a tumor infiltrate measuring 2 × 1 cm, spreading to the mouth of the left ureter. After preparation, the patient underwent surgery. Have a laparotomy. During the audit revealed that in the mid-ampullar part of the rectum there is a dense tuberous tumor that grows on the back wall of the bladder, the left ureter is expanded to 0.8 cm, the right one is not changed. Mobilization of the rectum, ureters, bladder, prostate, seminal vesicles was performed. The left ureter was crossed at the bladder. A cystotomy was performed with a vertical section of 4 cm. A flap was cut out of the urinary bubble triangle, the larger diameter of which was equal to the distance between the openings of the right ureter and the urethra, and departing from them laterally 3 mm, the smaller one was 1.2 cm. The mucosa was dissected along the perimeter of the planned flap with a scalpel muscle membrane of the wall of the bladder. The drug was removed. At the reconstructive stage, a cut flap was sewn into an orthotopic urinary reservoir from an isolated segment of the ileum. An anastomosis was applied between the left and right ureters according to the end-to-side type. The operation was completed by the formation of an unnatural anus and drainage of the pelvis. The wound is sutured in layers, tightly.

The postoperative period is smooth. There were no complications. The patient was discharged on the 15th day. 4 months later after surgery, the patient notes good health. According to ultrasound, no kidney pathology was detected. When excretory urography, it was found that the function of the right kidney is not impaired, the left - slightly reduced. Urination is free, painless.

The technical and economic effectiveness of the method lies in the fact that the application of a fundamentally new technique for transplanting a flap from the urinary bubble allows you to create an artificial urinary reservoir in such a way that the natural biological closure muscle apparatus of the ureter and urethra is preserved. At the same time, the quality of life improves and the long-term results of treatment of such patients improve.

Claims (1)

A method for transplanting the ureter into the intestine, including the use of a part of the urinary bladder triangle, characterized in that when the ureter is mobilized around its intravesical part and the urethral opening, a flap of ellipsoid shape is cut from the bladder wall, the larger diameter of which corresponds to the distance between the ureter and urethral openings, and departing from them laterally 2-3 mm, the smaller is determined individually depending on the anatomical structure of the urinary bubble and the degree of tumor damage to the bladder, but e less than 1 cm.