Transurethral resection of bladder tumor

Superficial bladder tumors, undiluted and submucosal, regardless of size, location and pathological grade, are applicable. Treatment of diseases: bladder tumors Indication Superficial bladder tumors, undiluted and submucosal, regardless of size, location and pathological grade, are applicable. Contraindications 1. The blood coagulation mechanism has serious obstacles. 2. The patient is too old and should be filled with poor general condition. Preoperative preparation 1. Patients who have undergone transurethral resection of the tumor require blood preparation. 2. Upper urinary tract tumors coexisting with intravenous pyelography should be performed. Surgical procedure 1. Before performing the electrotomy, check whether the resectoscope is in standby state. The resectoscope consists of three parts: the outer sheath, the core and the surgical mirror. It is most suitable for the inspection of the scope at an angle of 30°. The illumination and its cutting efficiency should be adjusted in advance. 2. Surgical electric cutters must use high-frequency electric cutting tools with a frequency of 1 to 3 million times per second, and common electric rings with a diameter of 0.25 mm to 0.3 mm. The electric cutter should generate an alarm sound when the pressure foot switch is pressed. The electric cutting and electrocoagulation foot should be able to emit different tones, and the operator can judge whether the used foot is correct from different tones. 3. Rinse solution: The rinse solution should be able to flow smoothly from a height of 1 m from the bladder. The rinsing fluid should be free of electrolytes to prevent electrical damage to the bladder and to make the electrosurgical unit lose its sensitivity during actual use. A commonly used rinse solution is 4% glucose solution, mannitol, sorbitol or 1.1% glycine. Distilled water can cause hemolysis and should not be applied. 4. Preliminary cystoscopy: Before the bladder tumor resection, the staging and grading of the bladder tumor and the bladder mucosa around the tumor were first understood. 5. Insert the resectoscope: Before inserting the resectoscope, insert a urethral metal probe to make sure that the diameter of the urethra is large enough. The No. 24 electric mirror sheath must be made of a 28 gauge metal probe. Inject lubricants such as glycerin or olive oil into the urethra to avoid the use of liquid paraffin, which produces oil beads and blurs the field of view. Insert the outer sheath of the resectoscope and its mirror core into the bladder, remove the mirror core, and replace the surgical mirror. Observe the characteristics of the tumor from various angles with a 30° angled endoscope. 6. Electric cutting to the muscular layer: All bladder tumors suitable for electric cutting should be cut open to the muscular layer. The technique of resection varies slightly depending on the size of the tumor, whether the tumor is papillary, pedicled, or broad-based and solid, and depending on its location. Small and pedunculated papilloma, 1cm diameter, is easily destroyed by bladder electrocautery and transurethral resection. Electric cuts should also be performed when a biopsy is required. When cutting, the bladder needs to be filled with the rinsing fluid. After the electric sputum is placed on the tumor, the electric cutting not only removes the base, but also includes a normal tissue around the base. The electric cutting does not have to be too deep. The sputum should be scraped onto the surface of the underlying muscle layer, and then the cutting edge of the resection area should be carefully observed and the residual tumor removed further. For a pedicled tumor of medium to large diameter of 3 to 4 cm, the pedicle can be severed first [Fig. 1 (3)]. First find the side of the tumor, it can be seen that the tumor villi hang over the normal bladder mucosa. Place the electric cleavage of the resectoscope behind the fluff, and then cut it in the direction of the surgeon to reveal the pedicle side. When the pedicle is cut thin, the tumor floats; when the pedicle is cut, the tumor drifts away from the field of view. Arterial hemorrhage in the electrocoagulation layer should not coagulate the bleeding in the villi. This type of bleeding is difficult to find, and the electrocoagulation of the pedicle can cut off the source of this bleeding. Check the cutting edge of the pedicle, use the backhand electric cutting method, that is, push the electric cutting to the opposite side of the surgeon, remove the residual tumor, but avoid cutting too deep. A wide-sized papilloma of the same size can be cut from one side of the tumor to the other using a long strip of electric cutting. The bladder should be kept inflated so that the bladder muscle layer under the tumor is elongated and concave, which is not easily damaged by electric cutting. Electrocoagulation of arteries from the muscular layer. Then continue cutting until the muscle layer reveals a flat base. As for the large papilloma that almost fills the bladder, as long as the muscle layer is not infiltrated, it can be completely removed in stages, but not from the pedicle. More tumors scattered in the distribution, can also be divided into electric cuts, usually after 2 to 3 operations, the basic can be completely removed. complication 1. Clot accumulation: After transurethral resection of bladder tumors, close attention should be paid to the accumulation of blood clots and shock caused by them. A balloon catheter should be inserted, and the blood clot in the bladder should be evacuated with a bladder aspirator, and the bladder should be flushed with a sterile rinse until the reflux is smooth. Under normal circumstances, the patient is not required to be returned to the operating room, and the blood clot is evacuated by electroporation and electrocoagulation to stop bleeding under anesthesia. 2. Extravasation of the urine: bladder perforation can occur unconsciously, leading to extravasation of urine. The patient may have abdominal pain, sometimes fever, and the lower abdomen may have a facial sensation. Under normal circumstances, it is only necessary to use a catheter to permanently drain the bladder. However, when there are perforations and clot accumulation, it is best to return the patient to the operating room, remove the blood clot under anesthesia and coagulate the bleeding point.