Local excision and electrocautery of bladder tumor

Bladder tumors are the most common tumors in the urinary male reproductive system, accounting for more than 60%, and most of them are epithelial tumors, accounting for more than 95%. Transitional cell tumors are the most common in bladder epithelial tumors, accounting for more than 80%, squamous cell carcinomas accounting for 3% to 6.7%, and adenocarcinomas accounting for 0.5% to 2.6%. Most of the transitional cell tumors in the bladder are a benign papilloma, but they are prone to recurrence and can be cancerous. Bladder transitional cell carcinoma is classified into grade 4 (G1 to G4) according to its degree of differentiation, and is classified into four stages according to its infiltration depth. The T1 phase (stage A) is limited to the mucosa (Ta) and submucosa. The T2 phase (B phase) is the tumor invasion of the muscular layer, in which the invasion of the superficial layer is B1, and the invasion of the deep muscle layer is B2. Stage T3 (C stage) is the tumor invading the whole layer of the bladder wall. In stage T4 (stage D), the tumor has metastasized. Only the metastasis to the surrounding organs or pelvic lymph nodes is D1, and those with distant metastasis are D2. Bladder transitional cell carcinoma is mostly superficial papillary carcinoma (Ta ~ T1 and G1 ~ G2), accounting for about 80%, of which 18% to 33% can be infiltrated into the muscle layer. The main symptoms of bladder tumors are intermittent, painless, gross hematuria, end-stage hematuria, and some bladder irritation, such as frequent urination, urgency, and dysuria. Cystoscopy and biopsy are the most common, important and reliable diagnostic methods. It can not only diagnose bladder tumors, but also determine its pathological tissue type and classification. The diagnosis of the bladder tumor can be preliminarily and roughly estimated by the two-handed diagnosis. B-mode ultrasound can detect bladder tumors with a diameter of 1 cm or more. B-mode ultrasonography in the bladder cavity may indicate the depth of invasion of the tumor. Urine cytology and flow cytometry are helpful in the diagnosis and prognosis evaluation of bladder tumors. In addition to the diagnosis of bladder-occupying lesions, CT scans may indicate the extent of tumor invasion and the presence or absence of pelvic lymph node metastasis. There are many treatments for bladder tumors, but they are still based on surgical treatment, combined with radiotherapy, chemotherapy, immunotherapy and laser treatment. The main basis for the choice of treatment plan is: 1 tumor stage; 2 tumor grade; 3 tumor pathological type; 4 tumor location, size, number and morphology; 5 bladder cancer cell DNA ploidy determination; 6 patient's age and body Health status. Estimation of staging and grading of bladder cancer before treatment is mainly based on the morphology and basal condition of the cancer observed during cystoscopy, biopsy, double-handed consultation, intraluminal B-mode ultrasonography, flow cytometry and CT scan. Treatment of diseases: bladder tumors Indication 1. Superficial bladder tumors > 3 cm in diameter. 2. Superficial bladder tumors that cannot be reached by transurethral resection and that cannot be illuminated by laser fibers. 3. Multiple papillary superficial bladder tumors that are difficult to count. 4. A large amount of bleeding in advanced bladder cancer, can not be controlled by various non-surgical hemostasis measures. Contraindications Invasive bladder cancer above T2 is not suitable for local resection and electrocautery. Preoperative preparation Place the catheter on the morning of the operation, release the urine, and inject anticancer drugs. For example, 100 ml of distilled water containing 10 mg to 20 mg of mitomycin C, clamp the catheter and fix it to prevent prolapse. Surgical procedure 1. Incisions generally use a midline incision in the lower abdomen. 2. Exposing the bladder to open the skin, cutting the subcutaneous tissue with an electric knife, and coagulation to stop the blood, then protect the skin with a gauze towel. The anterior rectus sheath was incised and the rectus abdominis and conus muscles were isolated. Transverse anterior transverse fascia of the bladder. 300 ml of physiological saline was injected from the catheter to fill the bladder to facilitate exposure. Push the peritoneum up and fully expose the bladder. 3. Bladder exploration first sutures the blood vessels in front of the bladder. Two needles were sutured on the bladder wall on both sides of the preparation for the incision with a No. 1 silk thread for traction. Or use two tissue clamps to clamp the bladder wall and lift it up. First, use an empty needle to puncture the bladder, such as pumping out the liquid, which proves to be the bladder. The liquid in the bladder is released through the catheter, so that the bladder is empty, so that when the bladder is cut, the liquid flows out to contaminate the wound, and then the bladder wall is cut longitudinally. Absorb the liquid remaining in the bladder with an aspirator. Exploring the bladder incision as needed. The bladder wall was retracted with a bladder hook to identify the location, size, number and base of the tumor. Use a pair of tweezers to gently lift the tumor pedicle. If you can loosen it, the tumor has not infiltrated into the muscle layer. Observe the distance between the two ureteral orifices and the tumor. If the distance is close, the ureteral catheter should be inserted through the ureteral orifice as a marker for tumor resection to avoid damage to the ureteral orifice. 4. The tumor is cut with a forceps to lift the tumor pedicle, or the tumor is clamped with a suitable size tumor scoop to reveal the tumor pedicle. Then, an anticancer drug such as mitomycin C is injected into the submucosa of the base of the tumor with an empty needle to cause the mucosa to bulge. The tumor was resected and excised from the normal mucosa 1 cm from the pedicle of the tumor. The bleeding point is treated by electrocoagulation to stop bleeding. If necessary, the blood can be sutured by 3-0 absorbable thread, and the base of the tumor is completely coagulated. The mucosal edges were sutured with a 3-0 absorbable thread. Small tumors can be electrocauterized directly with electrodes. 5. After intravesical instillation of the tumor and complete hemostasis, the bladder was infused with 1mg% to 2mg% nitrogen mustard solution or distilled water 200ml and soaked for 5min to kill the cancer cells in the bladder. After washing, rinse the wound thoroughly with distilled water. The surgical field is then rinsed with saline. The operator washes his hands, cleans the instruments, and replaces the cloth to remove the cancer cells that are shed to prevent planting and metastasis. 6. Bladder stoma In order to prevent secondary bleeding in the bladder after operation and clot obstruction of the ureteral lumen, it is better to choose the bladder stoma than the urethral indwelling catheter. A F26-F28 braided catheter was placed at the upper end of the bladder incision. The bladder incision was made as a full or stratified muscle layer with continuous or intermittent suture using a 2-0 absorbable line. The sarcoplasmic layer is then treated as a discontinuous sinus suture. 7. Place the drainage with isotonic saline thoroughly rinse the wound and absorb it, then put a rubber tube drainage in the posterior pubic space to prevent bleeding or accumulation of irrigation fluid to cause infection. The abdominal wall incision was sutured layer by layer. Fix the bladder stoma tube with skin suture to prevent prolapse. complication The main complication after bladder tumor resection is massive hemorrhage of the bladder. The reason is mainly due to secondary hemorrhage caused by infection when the tumor is cut off. Preventive measures are used to strengthen antibiotics within 2 weeks after surgery. After the bleeding occurs, the mild bladder may continue to flush, preventing the formation of blood clots and blocking the catheter. When there are more blood clots and can't be washed out, you can use the electric cutting mirror to wash and suck the blood clots. If there is bleeding point, use electrocoagulation to stop bleeding. When there is more bleeding, blood transfusion should be given. If the blood clot is full of the bladder and cannot be aspirated, the operation should be performed again, the bladder should be cut open, the blood clot should be removed, and the blood should be stopped.

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