Sigmoid bladder enlargement

Intestinal bladder enlargement includes ileal, colon, and ileocecal enlargement of the bladder, with ileal and sigmoid bladder enlargement being more common. Treatment of diseases: acute cystitis cystitis Indication 1. Urinary tuberculosis, the diseased kidney has been resected, the bladder has been scarred, the bladder capacity is less than 100ml, and the anti-tuberculosis drug has been treated for more than half a year. There is no pus ball or tuberculosis in the urine, and other parts of the body have been stabilized. 2. Non-inflammatory urinary frequency, bladder volume within 50ml. 3. Female interstitial cystitis is not cured for a long time. 4. Bladder tumors undergo partial cystectomy. The bladder volume is too small, or the bladder is completely resected. 5. There are serious complications after ureteral sigmoid anastomosis, which can not be controlled, and the lower urinary tract has returned to normal. Contraindications 1. Severe urethral stricture, can not be cured in a short period of time. 2. Bladder urethral sphincter dysfunction. 3. Patients with lesions in the ileum or colon (such as tuberculous lesions or multiple diverticulum). 4. There are still progressive tuberculosis in the systemic or urinary system. Preoperative preparation 1. On the 3rd day before surgery, enter a high-calorie, high-protein, low-slag diet to strengthen nutrition; 24 hours before surgery to give a fluid diet (double). 2. Sulfonamide 1g, 4 times a day, for 3 consecutive days. Or oral streptomycin was started 36 hours before surgery, 0.5g every 6 hours. 3. A few days before surgery, 200ml saline can be enema once, so that it stays and walks down to test whether there is no incontinence. 4. For 48 and 24 hours before surgery, each serving was 15 ml of castor oil. On the 2nd day before surgery, 2000ml of warm saline was used every night. Two hours before surgery, 500 ml of 1% neomycin was used for rectal enema to remove intestinal dirt. 5. Blood potassium, sodium, chloride and co2 binding. 6. Need to pay attention to pre-operative driving. Surgical procedure 1. Incision: median incision in the lower abdomen, extraperitoneal separation of the bladder; if the bladder is too small, easy to identify, a metal urethral probe can be placed into the bladder from the urethra to help identify. The separation should exceed the upper half of the bladder. 2. Separation of the ureter: Care should be taken to preserve the blood vessels in the preparation for later severance and anastomosis with the sigmoid colon. 3. Selection and free sigmoid colon intestine: incision of the peritoneum in the midline, sigmoid colon, selection of appropriate sigmoid colon fistula, it is estimated that the intestinal fistula must be free of tension with the bladder, and the sigmoid colon and vein preserved in the free mesangium Branches should be able to maintain adequate blood supply to the intestines. The length of the free intestinal fistula was about 15 cm, the intestine was cut, and a 1% neomycin solution and physiological saline were injected into the free intestinal lumen, and the washing was repeated until the reflux was clear. 4. Restoration of intestinal continuity: On the left side of the free intestinal fistula, the proximal and distal ends of the sigmoid colon are anastomosed to restore continuity. Before the anastomosis, the fat near the two ends should be peeled off to avoid the healing of the anastomosis and the formation of feces. 5. Resection of the diseased bladder: the ureter is cut off in the near bladder, and the ureter is inserted into the ureter with a No. 8 ureteral catheter to induce urinary flow. It can also be used as a stent for ureteral colon anastomosis. The posterior upper part of the bladder was removed, and the diseased tissue was removed as much as possible to make the remaining bladder a dish to reduce the chance of postoperative anastomotic stricture. 6. Anaesthesis of free sigmoid colon and bladder posterior wall: the distal end of the free sigmoid colon intestine is matched with the bladder. The outer wall of the anastomosis is sutured with a thin wire, and then the posterior wall is sutured continuously with 2-0 chrome. Mucosal layer. The anterior wall is reserved for suturing of the ureter and the free sigmoid colon fistula. 7. Anastomotic ureter and free sigmoid colon: The ureter and sigmoid colon fistula are matched by submucosal tunneling. On the colonic band, a longitudinal longitudinal incision of about 3 to 4 cm is made to form a tunnel, and the ureter is inserted into the intestine from a small mucosal incision at the distal end of the tunnel, and the sigmoid colon and the anterior wall of the bladder anastomosis are not sutured. The ureteral stump is then anastomosed to the end of the intestinal mucosal incision. The tunnel wall is then sutured to embed the ureter in the tunnel. A small incision is made in the anterior wall of the bladder or the anterior wall of the intestine, and the ureteral catheter is pulled out through the incision and drained to the outside of the abdominal wall. The catheter is sutured around the small incision and the catheter is fixed. In addition, an indwelling catheter is inserted from the urethra to drain the bladder. 8. Anaesthesia of free sigmoid colon and anterior wall of bladder: suture the anterior wall of the sigmoid colon and the anastomosis of the bladder. The mucosa was sutured continuously with a 2-0 chrome gut, and the outer layer was sutured with thin wires. 9. Close the proximal end of the free sigmoid colon: use the 2-0 chrome gut to suture the proximal end of the free sigmoid colon. Inject saline into the indwelling catheter and check for leaks in each suture. 10. Fix intestinal fistula, drainage, suture: suture the gap on the sigmoid mesentery with a thin thread, and fix the colonic tendon to the posterior abdominal wall to prevent the intestinal fistula from twisting. Then, the peritoneum was sutured, and the anastomosis of the sigmoid colonic bladder was placed in the peritoneum. Rinse the wound, place the cigarette in the posterior pubic space, and take it out from the lower end of the incision with the ureteral catheter. Finally, the abdominal wall incision is sutured layer by layer.