RU2297801C1 - Extravesical submucous ureterocystoanastomosis - Google Patents

Abstract

FIELD: medicine, urology.

SUBSTANCE: while anastomosing an ureter and a bladder or intestinal reservoir after cystectomy one should lance external sheath of a bladder that consists of adventitia and muscular wall, at the length of 4 ureteral diameters, one should bluntly prepare the sheathes laterally against the incision and put a distal end of ureter into the tunnel developed, Proximal ureteral end should be fixed towards external sheath. Then one should start suturing the external sheath by capturing external ureteral wall. Cystotomic incision should be fulfilled on internal sheath for the length being correspondent to the half of ureteral circumference length, ureter should be put into urinary reservoir so that 1 cm of ureter should remain in the lumen and it is necessary to finish the suturing procedure of external sheath. The innovation provides anti-reflux protection of ureterocysto- or ureteroreservoiroanastomosis that enables to apply it without wide lancing the bladder, prevent anastomosis stenosis and keep tissue hemodynamics.

EFFECT: higher efficiency.

9 dwg, 1 ex

Description

The invention relates to medicine, namely to urology, and consists in a method of anastomosing the ureter with the bladder during reconstructive interventions on the vesicoureteral segment or with the intestinal reservoir after cystectomy.

The prototype of the invention can be ureterocystoanastomosis according to Pereverzev-Mysko (monograph "Clinical urogynecology" by A.S. Pereverzev. - Kharkov: Fact, 2000. - S.331-333.) The method of ureterocystoanastomosis according to Pereverzev-Mysko is as follows: the ureter is laid and fixed interrupted sutures to the wall of the bladder over its four diameters (figure 1). Then the distal end of the ureter with fixing sutures is immersed in a cystotomy incision, the length of which corresponds to half the circumference of the ureter (figure 2). Then the fixed part of the ureter and anastomosis are immersed in a series of nodal adventitio-muscular sutures (figure 3).

However, the described method has several disadvantages (figure 4):

1. The clutch formed by all layers of the wall of the bladder is rehydrated and does not provide antireflux protection.

2. An immersion row of nodal adventitial-muscular sutures causes a violation of microcirculation, which leads to sclerosis and stricture of the anastomosis.

The objective of the invention is to provide antireflux protection of the ureterocyst or ureteroreservuaroanastomosis and its implementation without wide opening of the lumen of the urinary reservoir, to prevent stenosis of the anastomosis.

The objective of the invention is achieved by opening the outer (adventitious-muscular) case of the bladder over four diameters of the ureter, bluntly dissecting the cases away from the incision, and laying the ureter into the formed tunnel, suturing the outer case with the capture of the outer wall of the ureter, performing a cystotomy incision on the inner (mucous-submucous) case, the ureter is immersed in the urinary reservoir so that 1 cm of the ureter remains in the lumen. The anastomosis is ensured by a loose connection between the cases and the possibility of their preparation, antireflux protection is provided not by the entire wall of the reservoir, but by the internal (mucous-submucous) case and the nipple of the ureter. There is no inverting row of sutures, which causes a violation of tissue hemodynamics and sclerotic tissue changes in the area of the anastomosis. The safety of microcirculation is supported by the fact that the blood supply of the cases is performed by various vascular plexuses.

Features:

1) open the outer (adventitious-muscular) case of the bladder over four diameters of the ureter and bluntly prepare the cases to the sides of the incision;

2) the ureter is placed in the formed tunnel;

3) the proximal section and the "tunnel" part of the ureter are fixed to the outer case;

4) sutured the outer case with the capture of the outer wall of the ureter;

5) a cystostomy incision is performed on the internal (mucous-submucous) case;

6) the distal end of the ureter is immersed in the urinary reservoir, so that 1 cm remains in the lumen.

The invention is illustrated by the following figures:

figure 5 - opening of the outer case and the creation of the interfacial tunnel;

6 - suturing of the outer case with the fixation of the proximal end and the "tunnel" of the ureter;

Fig.7 - implantation of the distal end of the ureter into the urinary reservoir with immersion sutures;

Fig - the final view of the anastomosis;

Fig.9 is a transverse section of the anastomosis at the level of the tunnel.

The method is as follows.

On the example of the bladder. Having chosen a place for the anastomosis, the urinary wall is fixed with sutures with holders or Alice clamps, the outer case 1 of the bladder, consisting of adventitia and muscle wall, is opened over four diameters of the ureter. The outer 1 and inner 2 cases are bluntly prepared to the sides so that the ureter 3 can be freely placed in the formed tunnel (Fig. 5). The proximal end of the ureter 3 at the entrance to the tunnel is fixed with four nodal adventitio-muscular sutures 4. The outer case is sutured with nodular sutures 5 with the capture of the outer (relative to the bladder) ureter wall (Fig. 6). At the distal end of the tunnel, the inner case 2 is transversely opened to a length corresponding to half the circumference of the ureter and, removing the excess of the ureter 3, immerse the last with four interrupted sutures 6 into the lumen of the bladder 7 so that 1 cm of the ureter 3 remains in the lumen of the bladder 7 (Fig. .7). The closure of the outer case 1 is completed (Fig. 8). The cross section of the anastomosis at the level of the tunnel has the following form (Fig.9). The performance of ureteroreservuaroanastomosis is essentially the same. In order to maintain adequate blood flow, implantation of the ureter is recommended along the antispracheal edge of the intestine.

Thus, this method of ureterocyst or ureteroreservuaroanastomosis can be recommended for clinical use in urology. This method provides good antireflux protection of the ureterocyst or ureteroreservuaroanastomosis due to the mucous-submucosal valve and the nipple of the ureter. Anastomosis stenosis is prevented by maintaining a sufficient level of microcirculation and the absence of a wide coupling. In addition, the wide opening of the urinary reservoir is not required to create an anastomosis.

Claims (1)

A method of ureterocystoanastomosis, including laying and fixing the ureter, immersing the distal end of the ureter in a cystotomy incision, the length of which corresponds to half the circumference of the ureter, characterized in that the outer bladder case, consisting of adventitia and muscle wall, is first opened over four diameters of the ureter the cases are dissected away from the incision, and the ureter is laid in the formed tunnel, the proximal ureter is fixed at the entrance to the tunnel to the outer case, then the outer case begins to be sutured with the external ureter wall grasped, a cystotomy incision is made on the inner case and the ureter is immersed in the urinary reservoir so that 1 cm of the ureter remains in the lumen, after which the outer case is closed.

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