RU2454950C2 - Untegrade method of suprapubic epicystomy in case of intraperitoneal ruptures of urinary bladder - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to urology. Curved Kornsang clamp is introduced into cavity of urinary bladder through its intraperitoneal rupture. Above branches of Kornsang anterior wall of urinary bladder and aponeurosis are punctured. Above protruding in suprapubic region branches puncture of skin by means of scalpel is performed. In puncture wound branches of Kornsang clamp are introduced and used to grip drainage tube and bring it down into urinary bladder.

EFFECT: method makes it possible to reduce trauma of surgery due to absence of additional layer-by-layer cuts of anterior abdominal wall in suprapubic area, to perform complete control over installation of drainage into urinary bladder.

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Description

The invention relates to medicine, in particular to urology.

There is a method of suprapubic epicystostomy for urine diversion during intra-abdominal rupture or wound of the bladder, as well as damage to the bladder that occurs during surgical, oncological, gynecological and obstetric surgeries. With this method, after the lower median laparotomy and suturing of the intraperitoneal rupture of the bladder, suprapubic epicystostomy is performed (Lopatkin N.A. Guide to Urology // Edited by Acad. N.A. Lopatkin. - M .: Medicine, 1998. V.3, S.34-53 .; Tiktinsky O.L., Tiktinsky N.O. Injuries to the genitourinary organs // Peter 2002. S.161-232 .; F. Khinman. Operative urology. Atlas // Geotar-honey. 2001. S.560), which consists in performing an additional layered incision about 8-10 cm long in the suprapubic region (through the skin, subcutaneous fatty tissue, muscle-apon vrotichesky layer and predpuzyrnuyu fiber) to isolate the extraperitoneal anterior bladder wall, which is taken on the ligature taped and is opened for installation in its cavity drainage tube. In this way, a drainage tube is additionally installed in the prebubble fiber with this method. After the installation of the drainage tube into the bladder, the wound is sutured in layers.

The disadvantages of the above method are: 1) an additional layered incision in the suprapubic region with a length of 8-10 cm, 2) an increase in the time for performing an surgical intervention, 3) an increase in the volume of blood loss, 4) an increase in surgical trauma, 5) the formation of a long scar in the postoperative period, up to pubis, which in addition to the presence of a cosmetic defect, increases the risk of developing postoperative ventral hernia.

Close to the claimed is a method of suprapubic installation of a urinary catheter (drainage tube) into the bladder by performing a trocar cystostomy, which consists in layer-by-layer puncture of a front abdominal wall with a trocar in the suprapubic region to the bladder (A. Zakharov et al. Actual issues of the naval and clinical surgery // St. Petersburg 2009. - 31-32 s). To perform this method, after suturing the rupture, a urethral catheter must be installed in order to adequately fill the bladder with an aqueous antiseptic solution sufficient to conduct a trocar cystostomy.

The main disadvantages of the prototype are: 1) the inability to adequately fill the bladder for trocar cystostomy due to the lack of tightness of the sutured wound (as a result, an aqueous solution of the antiseptic from the bladder between the sutures of the sutured wound enters the abdominal cavity); 2) the risk of damage to internal organs and large vessels during trocar cystostomy; 3) in patients with benign prostatic hyperplasia, prostate cancer or urethral stricture, it is not always possible to install a urethral catheter necessary for filling the bladder.

The objective of the invention is to provide a safe, antegrade, fully controlled suprapubic epicystostomy for intraperitoneal ruptures of the bladder, while avoiding additional surgical trauma associated with an additional incision in the suprapubic region 8-10 cm long, with a layered discharge of the front wall of the bladder.

According to the invention, the task is achieved in that suprapubic epicystostomy for intra-abdominal ruptures of the bladder is performed by antegrade injection of a medium-sized curved clamp of Kortsang through the gap in the bladder cavity. Under visual control of the extraperitoneal passage by the jaws of the Kornzang clamp, the anterior wall of the bladder and aponeurosis are perforated. The skin in the suprapubic region is pierced above the jaws of the clamp with a scalpel. The branches of the curved clamp of Kortsang are brought into the created wound, which capture the drainage tube, the distal end of which is installed in the cavity of the bladder, where the catheter balloon is inflated. After this, the bladder wound is sutured tightly from the abdominal cavity.

This method allows to reduce the time of surgical intervention, avoiding additional surgical trauma and blood loss to establish

a drainage tube into the bladder cavity to divert urine during intra-abdominal ruptures, which is especially important in patients with combined trauma accompanied by shock of the II-III degree, as it allows to reduce surgical trauma and reduce the time of surgical intervention in the acute period of traumatic disease.

According to the scientific, technical and patent literature, the method of antegrade installation of a urinary catheter (drainage tube) through a puncture of the anterior abdominal wall in the suprapubic region, carried out over the jaws of the clamp introduced into the bladder cavity from the side of the wound from the abdominal cavity, is not known.

A method of installing a drainage tube for intra-abdominal ruptures of the bladder is shown in the drawings (Figs. 1, 2, 3).

Figure 1. Through a gap 1, a curved clamp Kortsang 4 is inserted from the abdominal cavity 3 into the bladder cavity 2, the branches 5 of which protrude above the anterior abdominal wall 6. Above the branches 5 of the clamp Kortsang 4, the anterior abdominal wall 6 is dissected with a scalpel 7.

Figure 2. Into the wound 8, jaws 5 of the Kortsang clamp 4 are removed, the drainage tube is captured by the jaws 5 of the clamp Kortsang 4 and is reduced into the cavity of the bladder 2.

Figure 3. After the balloon 10 of the Foley catheter 9 is inflated, the wound (rupture) of the bladder 1 is hermetically sutured from the abdominal cavity, the laparotomy wound 11 is also sutured in layers.

Clinical example. Patient I., 51 years old, medical history No. 47060/379033, was admitted with a closed abdominal injury. An examination revealed an intraperitoneal rupture of the bladder. Performed a lower middle laparotomy. An audit revealed a linear rupture of the bladder with a length of 3 cm in the apex. Through a gap in the bladder from the side of the abdominal cavity, a curved clamp Kortsang is introduced. The clamping jaws perforated the anterior wall of the bladder and aponeurosis in the suprapubic region. Above the protruding jaws of the clamp, the skin is dissected with a scalpel (1 cm incision). Through the created wound, the jaws of the clamp of Kortsang are brought out, which captured the drainage tube and are reduced to the cavity of the bladder. After removing the clamp, the Foley catheter balloon is filled with a solution of up to 30 ml in the cavity of the bladder. The wound of the bladder from the abdominal cavity is sutured tightly.

Claims (1)

A method of antegrade suprapubic epicystostomy for intraperitoneal ruptures of the bladder, characterized by antegrade holding a curved clamp Kortsang through a gap in the bladder cavity, above the branches of which the anterior abdominal wall is pierced, through the wound of which the branches of the Kortsang clamp are brought out to capture and lower the bladder into the urinary cavity.

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