SURGICAL METHOD FOR TREATING THE CASES OF EXTENSIVE INJURIES OR OBLITERATIONS OR MALIGNANT INJURIES IN LOWER URETER PORTION WITH URETEROCYSTOANASTOMOSIS

摘要

FIELD: medicine. ^ SUBSTANCE: method involves mobilizing a half of colon and rectum to expose ureters and posterior surface of the urinary bladder. Ureter mobilization and ureterolysis is carried out from renal pelvis to urinary bladder. The ureter is excised within the healthy tissue boundaries with ureter stump ligation following at the entry into the urinary bladder. The process extending to intramural ureter part, distal portion of the injured ureter is to be excised within the healthy tissue boundaries and a part of the urinary bladder is to be excised with urinary bladder wall being sutured by applying two-rowed interrupted sutures. Anterior and posterior urinary bladder wall is mobilized with right and left neurovascular fascicles being retained to cervix. Anterior urinary bladder wall is opened in transverse direction. Proximal ureter end is introduced through separate pierce in urinary bladder apex into its cavity with an excess of 1.5 cm. Ureterocystoanastomosis is created by fixing proximal ureter end from its lumen side. Ureter segment protruding into urinary bladder cavity is longitudinally cut within 1.0 cm limits with ureteral mucous membrane being additionally attached to the urinary bladder mucous membrane with ureteral invaginate, protruding into urinary bladder cavity, being created. Ureter wall is attached to urinary bladder mucous membrane with ureteral invaginate, protruding into urinary bladder cavity, being created. Ureter wall is attached to external urinary bladder wall with interrupted sutures. Polymer tube of internal diameter of 1-2 mm is introduced into the ureter from urinary bladder side, to renal pelvis. Urinary bladder body with its apex are moved into iliac region to eliminate ureter strain. Posterior surface and apex of the urinary bladder are attached to anterior surface of lumbar muscle. Draining tube is set in the urinary bladder. Ureter intubation tube is brought out with its fixation on urinary bladder wall. Urinary bladder wound is sutured. Body and apex of the urinary bladder are extraperitonized with moved parietal peritoneal flap created with ureterocystoanastomosis in iliac region on the opposite side with respect to urinary bladder attachment to lumbar muscle. The extraperitonized iliac region is drained from opposite iliac region. ^ EFFECT: recovered normal urine passage; eliminated ureterostoma; high reliability of ureterocystoanastomosis. ^ 7 cl