TsISTEKTOMYYa (Greek kystis a bladder + ektome excision, removal) — operation of removal of a bladder.
It is for the first time carried out in 1887 by B. Bardengeyer. C. make most often at cancer, a papillomatosis and an ectopia of a bladder. Operation is carried out in a planned order of ii as the exception is emergency at bleeding from a bladder to a losla of unsuccessful conservative actions.
Distinguish simple and radical Ts. Primenyavshuyusya earlier transvaginal C. in a crust, time do not make. The indication to simple C. at tumoral damage of a bladder existence of a widespread tumor is, at a cut it is impossible to execute a cystectomy. For carrying out simple C. nizhnesredinny or yakoreobrazny or cross access (see Jiaparotomiya) bare a front wall of a bladder. Then allocate its back wall, a bottom, area of a vesical triangle together with seed bubbles and a prostate. The hemostasis is carried out by bandaging of vesical arteries and veins. Ureters tie up as it is possible closer to a bladder. After crossing of vesical and pubic and vesicoureteral sheaves allocate the tail of an urethra, below a prostate impose Fedorov's clip and cut a bladder together with a prostate and seed bubbles at men
and an urethra at women.
The indication to radical C. extensive tumoral damage of a bladder with germination of a new growth in muscles or its distribution on surrounding bodies and fabrics serves. At radical C. together with a bladder and a prostate gland delete all paravesical cellulose with a fascia of a basin and regional limf, nodes. At women also the uterus, appendages and a front wall of a vagina are subject to removal.
Responsible stage C. the choice of a way of removal of urine is. The broadest application is found by intestinal plastics (see) or change of ureters in a rectum with formation of a so-called rectal bladder (see. At a reteroplastik). At the same time perform implantation of ureters in the rectum crossed and which is taken in on border with a sigmoid gut. The sigmoid gut with its sufficient length is reduced on a crotch near an anal orifice, the sphincter of a rectum performs functions of deduction of urine and a calla. At the successful result of operation with bringing down of a sigmoid gut of the patient feels desires both on an urination, and on defecation. The managed act of defecation is recovered, as a rule, by the end of the 6th week, rectum emptying happens every 4 — 5 hour. If bringing down of a gut is technically not feasible, then impose an unnatural anus (see Anus praeternaturalis). After operation of patients temporarily transfer to parenteral food (see).
As a result of C. the big cavity which needs to be drained well through an urethra or on Bu-yalsky — Mac-Uortera through a locking opening (see the Bladder) is formed.
The complications connected directly with in C., bleeding from pelvic veniplexes (a cut it is possible to stop by means of a hard tamponade), suppuration of a bed of a bladder, injury of a rectum are (see).
Bibliography: Erukhimovl. S. Rak of a bladder, M., 1975; Serenely -
in a JI. H. New growths of a bladder, M., 1967; Samsonov V. A. Tumors of a bladder, M., 1978; Shi pi-fishing V. I. Rak of a bladder, page 103, M., 1983; The biology and clinical management of bladder cancer, ed. by E. H. Cooper a. R. E. Williams, Oxford a. o., 1975; Skinner D. G. a. de Kernion J. B. Genitourinary cancer, Philadelphia a. o., 1978. B. P. Matveev.