RU2375975C1 - Method of urinary bladder resection - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to oncology and can be applied in surgical treatment of small pelvis tumors. For this purpose neck of urinary bladder is resected. After that left vesical vessels are mobilised, transected, preserved part of urinary bladder is turned on 45° counterclockwise. Then right and left ureters are sewn into preserved part of urinary bladder, loose end of urinary bladder is sewn to umbilical ring, epicystostoma is formed through umbilical ring.

EFFECT: method allows to preserve natural urinary reservoir and refuse from creation of artificial urinary reservoir, which reduces operative treatment duration, improves patient's life quality, reduces duration of patient's staying in hospital.

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Description

The invention relates to medicine, namely to Oncology, and can be used in the surgical treatment of pelvic tumors with germinating cancers.

A known method of resection of the bladder, consisting in cystoprostaty vesiculectomy with the formation of a heterotopic ileo-colonic urinary reservoir. (Kogan M.I., Perepechay V.A. "Modern Diagnosis and Surgery of Bladder Cancer", pp. 197-207, Publishing House CJSC, "Color Printing", 2002).

However, the above method has a significant drawback. The method does not involve the preservation of a natural urinary reservoir.

As a prototype, a method for resection of the bladder was chosen, consisting of the following: after exposure of the front wall of the bladder at the border of the neck and detrusor, two rows of sutures are placed between which the bladder is opened. Alternately, right and left dissect the bladder to the base. In this case, the removed part is sutured according to the principle of “small bubble”. They pull it up by the threads, raise the wall higher, thus facilitating the mobilization process. Finally, the entire portion of the bladder to be removed is sutured and remains fixed only by the ureters. Rear detrusor with preserved front wall. The tumor-containing segment is removed. (Polyanichko MF "Essays on operational and clinical oncourology", pp. 63-65. Publishing House SKNTs VSh, 2000).

The above method has a significant drawback.

The method provides for the possibility of autoplasty of the bladder from the muscles of the anterior abdominal wall or the front wall of the bladder. However, the above method does not allow the formation of a reliable bladder of sufficient volume.

The aim of the invention was to preserve the natural urinary reservoir.

The goal is achieved; by resecting the neck of the bladder with the bladder triangle during surgery, then mobilizing the bladder vessels, crossing them, turning the stored part of the bladder counterclockwise by 45 °, stitching the right and left ureters into the stored part of the bladder, stitching the free edge of the bladder to the umbilical ring, form an epicystostomy through the umbilical ring.

The invention "A method for resection of the bladder" is new, since it is not known from the level of medicine in the field of oncology, in the surgical treatment of pelvic tumors.

The novelty of the invention lies in the fact that it is possible to maintain a natural urinary reservoir.

The invention is industrially applicable, as it can be repeatedly reproduced and applied in healthcare, in medical institutions of a specialized profile, in general surgical and specialized oncology hospitals.

The method is as follows

During the operation, after removal of the drug, the left urinary vesical vessels are mobilized, cross them, turn the saved part of the bladder counterclockwise by 45 °, sew the right and left ureters into the saved part of the bladder, suture the free edge of the bladder to the umbilical ring, form an epicystoma through umbilical ring.

Example: Patient T-0, 65 years old, no. Disease 17930 / X was admitted to the Rostov Cancer Research Institute on September 26, 06 with a diagnosis of relapse of rectal leiomyosarcoma for surgical treatment. After the relapse was removed, the left urinary vesical vessels were mobilized, crossed them, the saved part of the bladder was turned counterclockwise by 45 °, the right and left ureters were sewn into the saved part of the bladder, the free edge of the bladder was sutured to the umbilical ring, an epicyst was formed through the umbilical ring. The patient was discharged on the 20th day in a satisfactory condition.

The technical and economic efficiency of the method lies in the fact that during the surgical treatment of tumors of the pelvis, it is possible to preserve the natural urinary reservoir and abandon the creation of an artificial urinary reservoir, which reduces the duration of surgical treatment and shortens the hospital bed.

Claims (1)

A bladder resection method, characterized in that the bladder neck is resected with the bladder triangle, then the bladder vessels are mobilized, cross them, turn the saved part of the bladder counterclockwise by 45 °, sew the right and left ureters into the stored part of the bladder, and hem the free ureters the edge of the bladder to the umbilical ring, forming an epicystoma through the umbilical ring.