METHOD FOR PREVENTING INTRAOPERATIVE BLEEDING DURING ENDOVIDOSURGICAL ADENOMEECTOMY

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to urology. After the implementation of retropubic access to the prostate, carbon dioxide is insufflated into the retropubic space. Then, using a puncture needle, the anterior abdominal wall is punctured in the area of ​​the pubic articulation through all layers of tissue. After visualization of the needle tip in the operating space, the tissues are punctured in the region of the dorsal complex of the prostate gland to the right of the urethra and 2.5 ml of the prepared remestip solution is injected, namely, up to 10 ml of 0.9% saline solution is added to 0.4 mg of the remestip. Then another 2.5 ml of solution is injected symmetrically to the left of the urethra, then 2.5 ml of the solution is injected into the region of the neurovascular bundles of the prostate on the right and left, and the puncture needle is removed. After 3-5 minutes, a cross-section of the anterior surface of the prostate capsule is made 1.5-2 cm below the proximal to the puboprostatic ligaments, 5-7 cm long. A layer is isolated between the capsule and the adenomatous tissue of the right and left lobes of the prostate gland. Then, bluntly and using the THUNDERBEAT apparatus, the adenomatous nodes are cut off. The prostatic part of the urethra is cut off, then small vessels are coagulated by bipolar coagulation, the adenomatous nodes are immersed in a container, after removal of the adenomatous tissues, the posterior wall of the bladder with the urethra is fixed proximally by 1 cm of the vas deferens with a continuous V-Loc thread with a length of 15 cm with a 5/8 cm needle , produce "trigonization" of the posterior wall of the bladder, followed by puncture of the needle on the anterior surface of the upper leaf of the prostate capsule and suturing along the right semicircle of the capsule of the prostate gland with the capture of the wall of the urinary bladder along the lateral, with the transition to the anterior surface, suturing the tissues on the left side symmetrically; the tightness of the anastomosis is controled. Then the container is removed. A tubular drainage is installed in the retropubic space. Sutures are applied to the skin, iodine treatment and an aseptic bandage are applied.;EFFECT: method allows to reduce the volume of the patient's surgical blood loss associated with profuse bleeding from the prostate tissue as a result of dissection of the surgical capsule.;1 cl, 1 ex, 2 tbl