Bricker ileal bladder

Bricker ileal bladder surgery is used for surgical treatment of ureter and bladder diseases. Urinary diversion surgery is a procedure that changes the normal discharge of urine from the urethra. Urinary diversion surgery can be divided into temporary and permanent categories. In addition to kidney, ureter, bladder, urethroplasty (or ostomy), urinary diversion surgery is often used in the following ways: 1 using a segment of free intestinal tract in the abdominal wall to create a channel for urine flow. Such as ileal bladder surgery and controlled ileal bladder surgery developed on this basis. 2 urinary feces confluence surgery, such as ureteral sigmoid anastomosis. 3 In recent years, the development of urine flow does not change, and the use of intestinal tube for bladder replacement surgery, such as ileal bladder surgery. Treatment of diseases: primary vesicoureteral reflux neurogenic bladder Indication Bricker ileal bladder surgery is suitable for: 1. Indications for temporary urinary tract surgery 1 severe ureteral reflux; 2 ureteral bladder obstructive disease; 3 refractory urinary tract infection; 4 some urethral obstructive diseases. 2. Indications for permanent urinary diversion surgery 1 neuronal bladder; 2 ectopic bladder; 3 after cystectomy. Preoperative preparation 1. Those with intestinal mites infection should be treated with deworming. 2. Preoperative bowel preparation and enema. 3. If there is severe anemia, imbalance of water and electrolyte balance, it should be corrected before surgery. Surgical procedure Incision A transverse incision or midline incision in the midpoint of the umbilical cord and pubic symphysis (Fig. 12.22.4.1-1A). The rectus abdominis sheath and the rectus abdominis were incised with an electric knife and entered the abdominal cavity. 2. Free ileal fistula Determine the ileocecal area and the distal ileum from the ileocecal area 10 ~ 15cm cut off about 12 ~ 16cm free ileal fistula, separate the mesentery, pay attention to save its blood supply. The intestinal lumen was rinsed with a 1:5000 nitrofurazone solution. 3. Restore the continuity of the intestine The proximal end and the distal ileal stump were made to the opposite end of the free intestinal fistula. The 3-0 silk suture was used to suture the whole layer and the suture was strengthened. Repair the mesenteric space. The appendix is routinely removed. 4. Free ureter The proximal end of the free bowel was closed with a 3-0 gut with two half-loads, and the muscle layer was reinforced with 3-0 silk. The pelvic and posterior peritoneum was cut on both sides of the sigmoid colon, and the middle and lower segments of the bilateral ureters were freed. The blood supply to the ureter was preserved, and the ureter was cut off near the bladder. The ureteral catheter No. 6 was inserted into the renal pelvis through the proximal rupture of the bilateral ureter. Use your fingers to free the passage behind the sigmoid colon and in front of the sac. Pull the left ureter to the right. 5. Ureteral anastomosis Two small round holes were cut at the proximal edge of the free ileum, the excess ureter was cut off, the end was beveled, and the ureteral drainage tube was fixed with 4-0 or 5-0 gut, using a 4-0 gut The ureter and the ileum are sutured in a full-thickness, and the external filaments are used to strengthen the suture of the muscle layer. The peritoneal wound margin was sutured, and the ureteral anastomosis was fixed to the peritoneum. 6. Ileostomy Cut a round hole in the skin between the middle and outer 1/3 of the anterior superior iliac spine and the umbilical cord. The "Ten" shape cuts the aponeurosis and muscles and reaches the abdominal cavity. The distal segment of the "ileal bladder" was pulled out of the channel, and the ileum was fixed to the peritoneum and the external oblique aponeurosis with a silk thread, leaving a segment of the intestine about 4 cm protruding out of the skin. The intestine tube was sutured with a silk thread to form a nipple of about 2 cm in length. Two ureteral catheters and an "ileal bladder" drainage tube were properly fixed. Indwelling the abdominal drainage tube and suturing the abdominal incision. complication Urine leak Most of the urinary leakage comes from the ureteral ileal anastomosis. As long as the ureteral stent drainage tube and the "ileal bladder" drainage tube are kept flowing smoothly, they usually stop by themselves. Intestinal fistula In addition to paying attention to the intestinal anastomosis technique, attention should be paid to the systemic nutritional status of the sick child. Postoperative attention to the supplement of nutrients is beneficial to prevent the formation of intestinal fistula. 3. Intestinal obstruction Intestinal obstruction is caused by intestinal adhesions. 4. Acute pyelonephritis The drainage of the ureteral stent drainage tube is easy to occur. Therefore, the drainage should be closely observed after the operation. If the drainage tube is blocked, the patient should wash the drainage tube with a small amount of antibiotic solution in time. 5. Anastomotic stricture Late complication of common ureteral ileal anastomotic stenosis, severe surgery must be corrected. 6. Ileostomy stenosis Regular expansion early in the postoperative period helps prevent the formation of stenosis.