controlled ileal bladder

Controlled ileal bladder surgery is an improvement of ileal bladder surgery, which uses ileal intussusception to form an anti-reflux nipple flap to prevent urine spillage to remove the urine bag that must be relied upon for ileal bladder surgery. Treatment of diseases: bladder and bladder injury Indication 1. Bladder basal or cervical invasive malignant tumor or extensive papillary tumor of the bladder, which cannot be treated by other methods. 2. Repeated multiple papillary carcinoma. 3. Bladder carcinoma in situ, bladder biopsy tumor cells are ii ~ iii grade. 4. Tuberculous contracture bladder with bladder neck or urethral stricture. 5. Congenital bladder valgus, failed after repair surgery. 6. Complex vaginal fistula of the bladder, repeated repairs are invalid. 7. Refractory interstitial cystitis. 8. Have done other urinary bypass surgery and do not want to wear urine bags. 9. Have done other urinary diversion surgery and the results are not satisfied. Contraindications Impaired renal function and creatinine above normal are the main surgical contraindications. Preoperative preparation 1. Preoperative physical examination, rectal examination and double abdominal examination, tumor biopsy and chest penetration, etc., to determine the nature of bladder tumors, depth of invasion and long-distance transfer. 2. Check blood urea nitrogen, creatinine and intravenous pyelography, etc., to understand the upper urinary tract function, with or without hydronephrosis, stones and tumors. 3. If ureteroscopic sigmoid anastomosis, the anal sphincter function should be understood before surgery, and if necessary, a barium enema examination can be performed, except for colon tumors. 4. Preoperative bowel preparation is the same as ureteral sigmoid anastomosis. 5. Rinse the bladder with saline under anesthesia before surgery until the reflux is clear. Leave the catheter in place. 6. Prepare blood 1000~1500ml. Surgical procedure 1. Position: supine, low head. 2. Incision and exposure: The choice of site of the abdominal wall fistula, the choice of abdominal incision position and the separation of the ureter are the same as the ileal bladder surgery. 3. Free intestine segment: After entering the peritoneal cavity, find the ileocecal part, freely with the mesenteric pharyngeal segment 60~70cm away from the ileocecal area, and the distal end 12~15cm for establishing the outlet and the water-resistant overflow intestine Laminated papillary flap; proximal 12-15 cm for ureteral implantation and establishment of anti-reflux intussusception papillary flap. 4. Incision of the intestine cavity: firstly fold the middle 40cm ileum in half or u shape, suture the mesothelial layer of the mesial lining with the 3-0 nylon thread, make the u shape fixed, cut the intestinal wall close to the suture, near The side end was cut more than 3 cm so that the two nipple flaps were not formed on one plane after the ileal bag was formed, and the entire wall of the posterior wall of the anastomosis was continuously sutured with the absorbable intestinal line. 5. Forming the nipple flap: through the incision of the intestine, the uncut end of the ileum is pulled in, forming a 5 cm long nest, respectively, and the gap and the outer edge of the nest are respectively sutured and fixed with 4 wires to establish the proximal end. Anti-reflux, distal invading intussusception nipple flap, make a small opening in the mesenteric of the proximal and distal end of the intestine, and take a 1cm wide rectus abdominis anterior sheath or nylon silk through the mouth. Take off slip. 6. Implantation of the ureter: suture closes the proximal end of the free ileum segment, and implants both ureters into the ileum between the end and the anti-reflux valve base, in which the stent catheter is placed. 7. Forming the ileal bag: the outer edge of the cut ileum is folded in half, and the suture stitch is used as a full-layer inversion to suture continuously to form the anterior wall of the anastomosis, and the suture is strengthened with a 3-0 nylon thread. urinary ileal bag. Push the ileal pouch down into the pelvic cavity and close the mesenteric space. 8. Fixation: The rectus abdominis anterior sheath strip or nylon strip at the base of the intussusception nipple flap is sutured into a ring shape, some of which are located between the intestine wall and firmly fixed to prevent the sleeve from slipping off. A circular incision was made in the anterior and posterior wall of the medial rectus abdominis muscle, and the rectus abdominis muscle was opened and extended to the cephalad to accommodate the mesenteric membrane. The nylon silk band was sutured and fixed to the front sheath to establish a flat abdominal wall ileostomy, and the drainage tube was placed through the stoma to the ileal bag. If the ileal bladder surgery is changed to the operation, the ileal graft ileum is connected to the proximal end of the controllable ileal bladder, and the ileal intussusception can also be used to form an anti-reflux papillary flap. In order to prevent the suture too tight and the intestinal wall erosion and the mesenteric wedge into the ileum slip, a 7-8 cm long mesangial area (window) can be formed on the planned ileal mesenteric, and the fixed intestine can be used. The nylon silk (the rectus abdominis anterior sheath) is widened to 2.5 cm, passes through the mesentery outside the mesangial area, surrounds the ileum, is partially embedded between the intestine wall, and is lined with fingers, with non-absorbent sutures. The silk strips are sewn into a ring shape and fixed to the bilateral intestinal walls. complication Urine spills.

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