TsISTOTOMYYa (Greek kystis a bladder - f-tome a section, a section; a synonym a cystotomy) — operation of opening of a cavity of a bladder.
C. apply during removal of foreign bodys, hl. obr. stones of a bladder. C. is an obligatory stage of each operation which is followed by opening of a cavity of a bladder — cystostomies
(see), cystectomies (see the Bladder, operations), ureterocystoneostomies (see), a transcystic adenomectomy (see Adenoma of a prostate), etc.
C. — one of the most ancient operations applied to a removing calculus. It is for the first time mentioned in the Old Indian medical treatise to Ayurveda (see). The first detailed description of a perineal lithotomy was made by A. Tseljs. In 16 century G. Romani and his pupils improved a technique of operation. At a perineal lithotomy the urethra and a neck of a bladder were inevitably injured that quite often led to an incontience of urine (see) and to uric zateka (see. Uric flowed). JIe H. F. Le Dran in 18 century offered the side perineal cystotomy which allowed to avoid the described complications.
In a crust, time of the most widespread nadlonny extra-peritoneal vesicotomy (epicystotomy, a high cystotomy, sectio alta) is. Operation is carried out under local or epidural anesthesia, and also under anesthetic. Position of the patient on spin with the raised basin; before operation enter a catheter into a bladder.
The section of skin 6 — 8 cm long is carried out on the centerline over a pubis. Cut hypodermic cellulose and a front wall of a vagina of direct muscles of a stomach; direct muscles of a stomach on the centerline move apart, a cross fascia make cuts in transverse direction. On a catheter enter 250 — 300 ml of oxygen into a bladder or sterile liquid; the filled bladder acts over a pubis and at a palpation clearly is defined in the depth of a wound. Move apart edges of a wound and open prevesical cellulose. In the stupid way remove a transitional fold of a peritoneum up and bare a front wall of a bladder, on to-ruyu impose two seams handles. On a catheter empty a bladder. The wall of a bladder is raised by means of seams handles and cut it in transverse direction. After unwinding the wound of a bladder is taken in a two-row catgut seam in two tiers. Paravesical cellulose is drained by means of the rubber graduate (see Drainage). The wound of a front abdominal wall is taken in layer-by-layer tightly. In need of drainage of a bladder operation is finished with imposing of suprapubic fistula (see Cystostomy).
The graduate delete from paravesical cellulose next day after operation. Recommend an early rising and activation of the patient; it promotes recovery of urodynamic and prevents emergence of a vesicoureteral reflux (see) and development of the ascending pyelonephritis (see). Urine is taken away by means of a constant catheter or catheterization of a bladder within 8 — 10 days (see Catheterization of uric ways), and in the presence of suprapubic fistula — through a drainage tube. Carry out antibacterial therapy.
Transabdominal vesicotomy is carried out at repeated operations and at cancer of a bladder. For its implementation after a nizhnesredinny laparotomy (see) loops of intestines take away up, delimit an abdominal cavity gauze napkins. After separation of a peritoneum from a wall of a bladder the last is cut between two seams handles. Completing operation, drain a bubble and take in its wound then the abdominal wall is sewn up layer-by-layer tightly.
In the postoperative period are possible discrepancy of seams, uric flow, suppuration of a wound. At observance of the technology of operation of complications, as a rule, it is not observed.
Bibliography: See bibliogrg to St. Cystostomy. V. V. Borisov.