total cystectomy

Total cystectomy removes the bladder, prostate, and seminal vesicles in men, and removes the bladder and urethra in women. Radical total cystectomy is a complete resection of the bladder, prostate, seminal vesicle, pelvic peritoneum, pelvic sidewalls and surrounding tissues of blood vessels (including lymph nodes and lymphatic vessels). In women, it also includes broad ligaments, uterus, cervix and part of the vagina. Treatment of diseases: bladder adenocarcinoma bladder cancer 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 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: The head is in a low supine position, and the tail of the tail is raised with a sponge pad. 2. Incision, revealed: the inferior midline incision, separation of the anterior bladder and both sides of the bladder, push open the peritoneal reflex, revealing the anterior wall of the bladder directly to the prostate. 3. Exploring the abdominal cavity: Incision of the anterior peritoneum, exploration of the liver and retroperitoneal and pelvic lymph nodes with or without metastasis, such as liver without metastasis, feasible surgery. If the lymph nodes above the pelvic cavity are swollen, the high-grade enlarged lymph nodes should be sent to the frozen section for examination to determine whether there is any metastasis; if there is metastasis, it is not suitable for surgery. Secondly, the detection of local bladder lesions, such as a small intestine or sigmoid colon fistula, should not be used as a basis for unresectable. 4. Cut the ureter: cut the peritoneum at the edge of the pelvic cavity, separate the ureter, cut the ureter 4 to 5 cm below the edge of the pelvis, and ligature the distal ligature and suture it, and leave it with the bladder (because the ureter is often infiltrated by the tumor) Therefore, the resection should not be too short). A ureteral catheter is inserted into the proximal end to drain the urine out of the surgical field to reduce abdominal cavity contamination. Cutting the ureter early can prevent the bladder from swelling after storage and affect the operation. 5. Separation of the bladder: Continue to peel the top and back of the bladder. When the peritoneum adheres to the bladder wall and suspected local infiltration, the peritoneum should be cut open at a distance of more than 2 cm from the edge of the adhesion to keep the peritoneum of the adhesion in the bladder wall. On, left to be removed. Then, the peritoneum was separated from the side wall from the posterior peritoneal incision, and the occluded umbilical artery and the vas deferens were respectively cut and ligated. The lower part of the vas deferens along the two sides is separated inward and downward until the bottom of the bladder. The superior bladder artery is severed and ligated. The lymph nodes below the bifurcation of the common iliac artery are separated downward together with the vas deferens. The bladder and prostate are bluntly separated until the top of the prostate. When separating the denovillier fascia between the prostate and the rectum, take care to prevent damage to the anterior wall of the rectum. The pubic ligament of the pubis is separated, cut, and the deep veins of the penis are ligated. 6. Cut the urethra: The urethral catheter is pulled out, the urethra is cut with a long-clamp clamp, and the proximal end is turned up, and the distal end is sutured with a No. 0 chrome gut. 7. Local removal: The bladder and prostate ligaments and the inferior bladder artery supplying the bladder and prostate are cut and ligated. The prostate, seminal vesicle, bladder, and local lymph nodes (near the iliac vessels, the femoral nerve, and the lymph nodes under the bifurcation of the abdominal aorta) were removed. If there is bleeding, most of them come from the genital venous plexus. They can be placed under the pubic symphysis to stop bleeding. They can be removed after ureteral sigmoid anastomosis or ileal bladder surgery. Generally, bleeding can be stopped. Therefore, it is not necessary to leave gauze stoppers. , can retain the gauze stopper. 8. Ureteral sigmoid anastomosis or intestinal cyst surgery (method see intestinal enlargement). 9. Drainage and suture: 3 to 4 cigarettes were drained in the bladder, and the incisions were sutured layer by layer.