RU2271748C1 - Method for forming urinostoma at heterotopic cystoplasty - Google Patents

Abstract

FIELD: medicine, urology.

SUBSTANCE: the present innovation deals with operative treatment of urinary bladder's cancer. In case of heterotopic cystoplasty one should apply the drainage through intestinal foramen into urinary reservoir. Moreover, at first, one should apply a silicone tube onto intestinal wall by leaving about 5 cm, not less against the edge of the tube up the edge intestinal foramen; it is necessary to apply sero-serous sutures at the distance of 5 cm above the tube, form serous channel above the tube, apply suture through the edge of serous channel; then one should suture intestinal wall with ligatures, then one should apply the ligature out of intestinal lumen outwards being 10 cm below the edge of edge foramen. Due to tightening the ligatures one should invaginate serous channel with the drainage into intestinal lumen; ligatures should be bound by fixing invaginate's edge towards intestinal wall; the tube should be withdrawn onto the skin that enables to develop a "dry" urinostoma.

EFFECT: higher efficiency.

1 dwg, 1 ex

Description

The invention relates to medicine, namely to the surgical treatment of diseases of the bladder, and can be used in surgical treatment of patients with bladder cancer after cystotomy during the formation of the urinary reservoir.

Known methods for the formation of ureterosigmocutaneostomy (Blokhin operation) and ureteroileocutaneostomy (Bricker operation) (Lopatin N.A., Darenkov S.P., Chernyshev I.V. et al. "Radical treatment of invasive bladder cancer", Journal "Urology", 2003 No. 4, pp. 3-8). These methods have a significant drawback: a big problem that aggravates the life of patients is the presence of a weeping urinostoma, maceration of the skin around.

As a prototype, a method for the formation of a urinostomy was selected, which consists in narrowing the distal part of the tubular segment with interrupted sutures (Vicryl 3.0) along the mesenteric edge on Fole No. 10 catheter and fixed conduit with separate interrupted sutures to the peritoneum (inside), aponeurosis to the skin (outside) - urinostoma (Gotsadze DT “Long-term results of continental diversion of urine to the skin into a detubularized small intestinal reservoir”, Urology Journal, 2003, pp. 18-22.

The method has significant disadvantages:

1. The method does not prevent urine from entering the skin.

2. The narrowing of the distal part of the detubularized segment of the intestine above the tube is not enough to prevent urine reflux from the reservoir.

The aim of the present invention is the formation of a dry urinostomy from the intestine with a valve mechanism, eliminating the possibility of constant leakage of urine from an artificial bladder to the skin.

This goal is achieved by the fact that in the formation of a dry urinostomy with intestinal vesicoplasty, the distal end of the intestinal transplant is used, from which the serous channel is formed, which is invaginated into the intestinal lumen, which eliminates the possibility of constant leakage of urine from the heterotopic bladder to the skin.

The invention "A method for the formation of a urinostomy with heterotopic cystoplasty" is new, as it is not known from the level of medicine, namely in the surgery of diseases of the bladder.

The novelty of the invention lies in the fact that during the formation of a uronostoma with intestinal vesicoplasty, a serous channel is created from the distal end of the intestine, which is subsequently invaginated into the lumen of the graft.

The invention has an inventive step, since for a specialist surgeon does not explicitly follow from the level of medicine in this field of surgery. In the available information sources of Russia, the CIS and foreign countries, we were not able to find a similar method to the proposed urinary reservoir formation.

The invention, “A method for the formation of a urinostomy in heterotopic cystoplasty” is industrially applicable, as it can be repeated and used repeatedly in the surgical treatment of bladder cancer in specialized medical institutions, especially oncology: oncology dispensaries, cancer research institutes.

The method is as follows (see drawing).

Bladder removal is performed. Heterotopic vesicoplasty is performed from the small or large intestine. A silicone tube (2) is placed on the wall of the distal end of the intestine (1), leaving at least five centimeters from the edge of the tube to the end hole in the intestine. Single gray-serous sutures (3) are applied over five centimeters above the tube, forming a serous canal above it (4). A single suture (5) is applied, stitching the edge of the serous canal, the suture is tightened. The ligatures of the suture stitch the wall of the intestine, conducting ligatures from the lumen of the intestine outward ten centimeters below the edge of the end hole. Pulling the ligatures invaginate the serous canal with drainage into the intestinal lumen. Ligatures bind, fixing the edge of the invaginate to the wall of the intestine. Subsequently, the urinostom is formed on the anterior abdominal wall, fixing in a circle to the peritoneum and to the skin.

Example:

Patient T-ko, 72 years old, was admitted to the clinic of RNII on October 7, 2003 with a diagnosis of bladder cancer, art. 3 gr. 2 T ₃ N ₁ M ₀ . The patient on October 8, 2003 underwent surgery in the amount of: cystectomy. Subsequently, heterotopic vesicoplasty was performed from an isolated segment of the ileum. The continuity of the gastrointestinal tract is restored by the formation of a small intestinal anastomosis. A silicone tube was placed on the wall of the distal end of the intestinal transplant, leaving five centimeters from the edge of the tube to the end hole in the intestine, single gray-serous sutures were placed over five centimeters above the tube, forming a serous channel over the tube, and the serous channel with drainage was invaded into the intestinal lumen. Subsequently, the urinostom was formed on the anterior abdominal wall, fixing in a circle to the peritoneum and to the skin. The postoperative period was uneventful. On the 14th day, the patient in satisfactory condition was discharged from the hospital.

The proposed method for the formation of dry urinostomy was used in the surgical treatment of 25 patients. In none of the cases in the postoperative period were there any complications.

The technical and economic efficiency of the developed method lies in the fact that the formation of a dry urinostomy with a valve eliminates the possibility of constant leakage of urine from an artificial bladder onto the skin, which in turn helps to improve the quality of life by restoring the frequency of passage of urine and preventing the development of purulent-septic complications, associated with the failure of the urinostoma and irritation of the skin around it. The immediate results of surgical treatment of patients with bladder cancer are improving.

Claims (1)

A method for the formation of a urinostoma with heterotopic cystoplasty, which consists in installing a drainage tube through an opening in the intestine into the urinary reservoir, removing the tube on the skin and fixing the intestine around the opening to the skin of the urinostomy, characterized in that the silicone tube is laid on the intestinal wall, leaving at least 5 cm from the edges of the tube to the end hole in the intestine, impose single gray-serous sutures for 5 cm above the tube, forming a serous channel above the tube, impose a single suture, stitching the edge of the serous canal, suture tighten, suture the intestinal wall with ligatures, passing ligatures from the intestinal lumen outward 10 cm below the edge of the end opening, pulling the ligatures, invaginate the serous channel with drainage into the intestinal lumen, ligatures are connected, fixing the edge of the invaginate to the intestinal wall.