[尿内镜真空治疗的首例报告：用于直肠腹会阴切除术后的大膀胱缺损。视频论文。德文版]

[First report of urinary endoscopic vacuum therapy : For large bladder defect after abdomino-perineal excision of the rectum. Video paper. German version].

作者信息

Loske G, Schorsch T, Kiesow R U, Müller C T

机构信息

Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Katholisches Marienkrankenhaus Hamburg gGmbH, Alfredstraße 9, 22087, Hamburg, Deutschland.

Urologische Klinik, Katholisches Marienkrankenhaus Hamburg gGmbH, Hamburg, Deutschland.

出版信息

Chirurg. 2017 Jan;88(1):37-42. doi: 10.1007/s00104-016-0297-8.

DOI:10.1007/s00104-016-0297-8

PMID:27981370

Abstract

PURPOSE

The technique of active urinary endoscopic vacuum therapy (uEVT) is described. The surgical technique is demonstrated in detail with the help of a video of the operation and which is available online. Vesical fistulas are a rare complication following rectal surgery. The EVT technique is a novel method for treatment of gastrointestinal leakage. This endoscopic procedure has been adapted to treat a large bladder defect after abdominoperineal resection of the rectum with urine flowing out of the perineal wound.

MATERIAL AND METHOD

A new open-pore film drainage (OFD) catheter with an external diameter of only a few millimeters has been developed and is constructed from a very thin open-pore double-layered film and a drainage tube. The OFD was inserted into the bladder by means of flexible endoscopy and channeled out through a suprapubic incision. Continuous suction was applied with an electronic vacuum pump to actively drain the urine completely. A passive catheter drainage of urine from the renal pelvis via transurethral single J stent was carried out simultaneously during the complete duration of treatment. The healing process was monitored during and after therapy by intravesical endoscopy.

RESULTS

The application of continuous negative pressure via the OFD resulted in total collapse of the bladder. The urine in the bladder was actively and permanently drained through the OFD. Urine leakage from the perineal wound stopped immediately after induction of suction. After 18 days of treatment with the uEVT the bladder defect was healed. After therapy and removal of the catheters the patient had normal micturition.

CONCLUSION

A novel small-bore OFD has been developed for EVT. The OFD technique now allows endoscopic application of negative pressure in the bladder. This first successful experience proves uEVT to be a potent interventional alternative in the treatment of bladder defects.

摘要

目的

描述主动式尿液内镜下真空治疗（uEVT）技术。借助手术视频详细展示了该手术技术，该视频可在线获取。膀胱瘘是直肠手术后罕见的并发症。EVT技术是治疗胃肠道漏的一种新方法。此内镜手术已被应用于治疗经腹会阴直肠切除术后出现的大的膀胱缺损，尿液从会阴伤口流出的情况。

材料与方法

已研发出一种外径仅几毫米的新型开孔薄膜引流（OFD）导管，它由非常薄的开孔双层薄膜和一根引流管构成。通过软性内镜将OFD插入膀胱，并经耻骨上切口引出。使用电子真空泵持续吸引以主动彻底引流尿液。在整个治疗期间，同时经尿道单J支架进行从肾盂的被动尿液导管引流。在治疗期间及之后通过膀胱内内镜监测愈合过程。