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首页> 外国专利> METHOD FOR EXTRAPERITONEAL RADICAL PROSTATECTOMY WITH USE OF EPIDURAL ANAESTHESIA

METHOD FOR EXTRAPERITONEAL RADICAL PROSTATECTOMY WITH USE OF EPIDURAL ANAESTHESIA

机译：硬膜外麻醉用于腹膜外根治性前列腺癌的方法

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FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely to urology, and can be used for surgical management of prostate cancer. In patient's position lying on side or in sitting position, skin is treated in triple way with aqueous 70 % ethanol solution. Then under local anaesthesia 2.0 ml of 2 % lidocaine with Tuohy 20G needle at L1-Th12 level is punctured and catheterized epidural space, wherein catheter is performed in cranial direction by 3 cm. Puncture needle is removed, an aseptic sticker is applied with catheter fixation to skin of back, patient is placed on back and test dose 3.0 ml of 2.0 % solution of lidocaine is introduced. If blood pressure and heart rate is stable and 98–99 % blood saturation is used, 10.0 ml of 1.0 % ropivacaine solution is administered. In 15 minutes after development of sensory block to level Th8 and satisfactory motor unit for sedation by means of syringe pump, microfluid introduction of 1 % propofol in amount of 3–5 mg/kg*h is started. Thereafter, skin incision 2.0–2.5 cm long is made in periomphalic region 3 cm below the umbilicus, and a retropubic space is inserted in layers. Primary cavity is formed by means of the index finger. Working space is then formed in a retroperitoneal way by means of a manual bullet dilator, then a laparoscope is introduced into it. If the balloon dissector is properly positioned, it is removed and a laparoscope is inserted through the above access into the working cavity. Then trocars and ports are placed: two trocars with diameter equal to 5 mm, through scalpel skin punctures are installed on 3 cm to the right and to the left of the main access. Two ports, the diameter of the first of which is 12 mm, of the second one - 5 mm, are positioned on the iliac spines. Installation of the first twelve-millimetre port is performed at 3 cm median of right iliac bone through skin incision 1 cm long, installation of second five-millimeter port - similarly to the left. That is followed by sequential skeletonisation of an anterior prostate and bladder surface, alternate formation of two tunnels on the right and left of a projection of a bladder neck in a layer of adipose tissue located medial to a tendon pelvic arch and lateral to pubovesical complex, until deferent ducts and seminal vesicles appear. On the inner surface of the formed tunnels, the outer lateral bundles of the detrusor and the vesicle-prostatic muscle are verified and transected, thus freeing the proximal urethra along the posterolateral semicircle. Then, the tunnels are combined. Further, the prostate base contour is moved from the depth to outside from 6 to 12 o'clock of the conventional clock face; detrusor front apron is split cranially; intersecting the proximal portion of the intraprostatic urethra; seed complex is separated and seed ducts are transected. It is followed by posterior dissection of prostate; separating the layer between the lateral periprostatic, intramuscular fascia and the fascia of the muscles lifting the anus until the pubic peroneal muscle is exposed on both sides, orientated on the adipose tissue layer between the pubovesical complex and the front periprostatic fascia, they are separated to urethral sphincter. Dorsal venous complex is not pierced; distal urethra is separated and transected; prosthetic gland is moved into container for further extraction; anastomosis is applied between the proximal urethra and the bladder neck by continuous self-tightening sutures. Profiled urethral Foley 18Ch catheter is inserted. Cylinder is inflated to 10 ml and tightness of anastomosis is monitored by administering 150 ml of sterile physiologic saline. Prostate and seminal vesicles are removed by single unit in container through central port access.;EFFECT: method provides eliminating the development of negative consequences and maximum radicality when removing a tumour, an involved organ and regional lymph nodes by reducing the probability of perioperative complications of general anaesthesia and reducing trauma of the surgical intervention.;1 cl, 6 tbl, 1 ex
机译：领域：药物;发明：本发明涉及药物，即泌尿科，并且可以用于前列腺癌的外科治疗。在患者侧卧或坐姿时，可用70％乙醇水溶液对皮肤进行三重处理。然后在局部麻醉下，用Tuohy 20G针在L1-Th12水平穿刺2.0 ml的2％利多卡因并将其插入硬膜外腔，其中沿颅骨方向进行导管插入3 cm。取下穿刺针，将无菌胶粘剂固定在背部皮肤上，并将导管固定在背部皮肤上，将患者置于背部并引入3.0毫升2.0％利多卡因溶液的测试剂量。如果血压和心率稳定并且使用了98％至99％的血液饱和度，则应服用10.0 ml的1.0％罗哌卡因溶液。在感官阻滞发展到Th8水平并通过注射泵使镇静装置达到满意的镇静作用后15分钟内，开始微流体引入浓度为3-5 mg / kg * h的1％异丙酚。此后，在脐下方3 cm的脐周区域切开2.0–2.5 cm长的皮肤切口，并在各层中插入耻骨后间隙。主腔是通过食指形成的。然后通过手动子弹扩张器以腹膜后方式形成工作空间，然后将腹腔镜插入其中。如果正确放置了球囊解剖器，则将其取出，并通过上述通道将腹腔镜插入工作腔。然后放置套管针和端口：将两个直径等于5 mm的套管针通过手术刀皮肤刺穿，安装在主通道右侧和左侧3 cm处。 ports骨棘上有两个端口，第一个的直径为12 mm，第二个的直径为5 mm。第一个12毫米端口的安装是在右1骨中部3厘米处通过1厘米长的皮肤切口进行的，第二个5毫米端口的安装则与左侧类似。随后依次进行前列腺和膀胱前表面的骨架化处理，在位于颈肌腱骨盆弓内侧和耻骨小管复合体外侧的一层脂肪组织中，在膀胱颈投影的左右两侧交替形成两个隧道，直到出现不同的导管和精囊。在已形成的隧道的内表面，逼尿肌和囊泡前列腺肌的外侧束被验证并横切，从而沿后外侧半圆释放尿道近端。然后，将隧道合并。此外，前列腺的基础轮廓从传统钟表的深度从6点移动到外部12点。逼尿肌前围裙颅骨裂开;与前列腺内尿道的近端相交;分离种子复合物并横切种子管。随后进行前列腺后路解剖;将外侧前列腺周围筋膜肌筋膜与提起肛门的肌肉筋膜之间的层分开，直到耻骨腓骨肌在两侧暴露，并定位在耻骨复合体和前列腺前筋膜之间的脂肪组织层上，将它们分离为尿道括约肌。背静脉复合体未刺破;尿道远端分离并横切;将义齿腺移入容器中进一步提取;通过连续的自紧缝合线在近端尿道和膀胱颈之间进行吻合。插入异形尿道Foley 18Ch导管。将气瓶充气到10毫升，并通过施用150毫升无菌生理盐水来监测吻合的紧密度。前列腺和精囊通过中央端口进入容器中，由单个单元去除。效果：该方法可消除肿瘤，累及器官和局部淋巴结的可能性，从而减少了围手术期并发症的可能性，从而消除了不良后果的产生和最大程度的根治全身麻醉和减少手术干预的创伤。; 1 cl，6 tbl，1 ex

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