SU1475604A1 - Method of forming an artificial urinary bladder - Google Patents

Abstract

The invention relates to medicine, in particular, to methods for creating a urine reservoir from rectal tissue after cystectomy. The aim of the invention is the elimination of direct intestinal ureteral reflexes. Cystectomy is performed, the recto-sigmoid section is stitched with two mechanical sutures, the intestine is cut between them, the proximal end is mobilized and temporarily left. The peritoneum is dissected on both sides of the rectum, the sheets of peritoneum are peeled off towards the ureters, mobilized extraperitoneally, brought on both sides to the side walls of the rectum, rotated in the proximal direction and fixed at the site of the bends to the side walls of the rectum. Adventitial and muscular layers of the intestinal wall at the places of fixation of ureteral bends are dissected, they are conducted in the tunnel along the submucosal layer in the proximal direction, the angles of the mechanical seam of the rectum are cut off, the mucous membranes of the ureters and rectum are compared. A part of the rectal stump is invaginated to the level of fixation of the ureters to the side walls. Consistently sew the adjacent walls of invaginate, cover the ureteral-rectal anastomoses with sheets of peritoneum isolated during the mobilization of the ureters, and perform a sigmostomy. 3 il.

Description

Hom shows the cut levels of the corners of the mechanical seam); in fig. 2 - position of the ureters in the submucosal tunnel before invagination of the rectal stump | FIG. 3 shows the position of invagination and the mouth of the ureters in the bladder formed according to the proposed method.

The proposed method form the bladder as follows.

Cystectomy is performed, the recto-sigmoid department is stitched with two mechanical stitches, the intestine is cut between them, the proximal end is mobilized and temporarily left, the peritoneum is cut on both sides of the rectum, the sheets of the peritoneum are peeled off towards the ureters, they are mobilized out of the rectum, from both sides to the side walls of the rectum, rotated in the proximal direction, fixed in the place of bends to the side walls of the rectum, after which the adventitious and muscular layers of the rectal wall are cut down Causes of ureteral bends, they are carried out in the tunnel along the submucosal layer in the proximal direction, the angles of the mechanical suture of the rectum are cut off, the mucous membranes of the ureters and the rectum are aligned, after which part of the rectal stump is invaginated to the level of fixation of the ureters to side walls. Consistently sew the adjoining walls of invaginate, cover the ureteric-rectal anastomoses with peritoneal sheets that were isolated during the mobilization of the ureters, and perform a sigmostomy.

Example. Patient B., 47 years old. An operation was performed on cystectomy, forming a bladder from the rectal stump, sigmostomy. After laparotomy and revision of the abdominal organs of distant metastases were not revealed. Cys, tectomy, ureters are cut off in the juxtaseic departments, the bladder is peritonized. On both sides of the rectosigmoid department, the peritoneum is cut 15 cm from each side, the ureters are mobilized in abdominal mode and removed into peritoneum incisions. The sigmoid gut mobilized and recto-ogmoid transition twice hemmed apparatus UO-40 Between fur

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The gut is crossed by nical sutures. Both ureters are alternately turned in the proximal direction and placed along the side walls of the rectum stump with free ends to the mechanical stitch of the stump. In places of bends, the ureters are fixed to the side walls of the rectum, the stacks are incised to the submucosal layer, in which tunnels are made to the corners of the mechanical suture. The latter are cut off, ureters are made in the tunnels, the mucous of which is matched with the rectal mucosa by four catgut interrupted sutures. Next, the mechanical suture is immersed gradually in the lumen of the stump; the adjacent rectal walls are fixed with catgut interrupted sutures up to the level of ureteral fixation.

Peritoneal sheets sutured together over the ureteral-intestinal anastomoses. Imposed sigmostoma in the left iliac region. Postoperative course without complications. Voloma was examined after 3 months. During rectoneocystography the capacity of the formed bladder is 150 ml, there is no ureteral reflux. On the excretory urogram, kidney function and urodynamics are unchanged.

The proposed method of forming an artificial bladder provides a positive effect in forming an artificial pulp on the terminal sections of the ureters, the role of which is invaginate walls and the rectum stump, between which the terminal sections of the ureters are placed, which excludes the ureteric reflc ss

According to the proposed method, 9 patients were operated on.

Claims (1)

Invention Formula A method of forming an artificial bladder, comprising: creating a container for: urine from the rectum by cutting it off from the sigmoid and mechanical suture with the subsequent invagination of a part of the stump, applying the ureteral-rectal anastomosis by forming the mucous tunnels in the wall of the rectum and conducting in them are the stumps of the ureters, fixing their distal parts to the side walls of the direct kit 1 FIG. 2 FIG. five