Surgical operations always cause fear in people, because any intervention has risks. However, it is impossible to do without these manipulations. One of the surgical interventions is cystectomy. This is a procedure that is performed in various branches of surgery. It is indicated in cases where conservative therapy has no effect. As with any surgical procedure, cystectomy is performed only under strict indications. It is appointed only by a specialist after examination. The operation is performed under stationary conditions. Before it is necessary to prepare the body.
Cystectomy - what is it
As you know, each surgical intervention belongs to one or another surgical profile. For example, urology, proctology, oncology, etc. Nevertheless, there are a number of such procedures that are considered universal. One of them is cystectomy. This is an operation, which means the removal of a cyst. Such a benign formation can appear in almost any internal organ. A cyst is a cavity that is round or ovalmolds filled with liquid content. Most often it is found in the ovaries, liver, kidneys, bladder. Also, a cyst can form in the dental canals and gums.
In addition, there is such an operation as cystectomy of the bladder. This surgical intervention has a completely different meaning, since it is not associated with cysts. This medical term refers to the removal of the organ itself - the bladder. Often, such an operation is performed due to oncological pathologies.
For what diseases is cystectomy performed
Cystectomy is a radical method of treatment, as it involves the complete removal of the cyst with its shell. This procedure is performed by surgeons of various profiles. Among them are specialists performing operations on the organs of the chest and abdominal cavity, urologists, oncologists, dentists, gynecologists. Despite this, every surgeon should master the technique of removing a cyst. And yet, for what diseases do cystectomy? Despite the fact that a cyst can form in almost any organ, such an operation is not always performed. Sometimes a benign formation is treated with medication. In some cases, it is necessary to remove the entire organ (for example, with a large cyst in the kidney). It should be borne in mind that there are contraindications to cystectomy. Sometimes it is not advisable to perform such an operation due to the high risk to he alth. Conditions for which a cystectomy is performed include:
- Ovarian cyst. I mean great educationwhich does not respond to other types of treatment.
- Liver cyst. Most often, such formations contain not only fluid, but also a parasite (echinococcosis). In this case, surgery is the only treatment.
- Cyst in the mouth. It may have different localization. This disease is treated by a dental surgeon.
- Cyst of the pancreas. Despite the fact that this is a benign neoplasm, operations on this organ are dangerous. Therefore, a pancreatic cystectomy should be performed by an experienced specialist.
In addition to the listed diseases, surgery may be required for cysts of the breast and thyroid gland, coccyx, etc. In these cases, treatment tactics are determined depending on the size of the formation.
Indications for radical cystectomy
In addition to removing cysts from organs, radical cystectomy is an operation on the bladder. The main indication for its implementation is a cancerous tumor. A malignant formation can either develop in the bladder itself or grow into the thickness of the organ from nearby tissues. Most often, these tumors include cancer of the cervix and endometrium, ovaries, prostate and rectum. Cystectomy of the urinary organ (bladder) is its complete or partial removal. Given that such a procedure is traumatic and leads to disability, it is performed only in cases where other treatment options do not help. The following pathologies are considered indications for cystectomy:
- Advanced cervical cancer andbody of the bladder, growing into the thickness of the tissue.
- Multiple papillomas located on the inner surface of the organ.
- Tumor recurrence after previous surgery (recurrent cancer).
- Germination of a malignant neoplasm into the bladder from adjacent organs.
For less aggressive cancers, surgeons try to avoid radical cystectomy. In such cases, they are limited to partial removal of the organ in the place where the tumor is located.
Preparing for bladder cystectomy
Operation cystectomy is a massive abdominal surgical intervention. Therefore, before proceeding with the procedure, the patient's body should be prepared. Since the operation can lead to the development of an infectious process in the pelvis, it is necessary to start taking antibiotics in advance. Recommended drugs "Erythromycin" and "Neomycin". Also, 14 days before surgery, medications containing bifidus and lactobacilli should be taken. They are needed not only because of antibiotic therapy, but also to improve bowel function after surgery.
Given that the organs of the digestive system border on the bladder, a special diet is required. 3 days before cystectomy, indigestible foods should be excluded. It is allowed to drink liquids (boiled water, mineral water without gas, tea, juices), broth and jelly. On the eve of the operation, bowel cleansing is performed. For this purpose, speciallaxatives or a series of enemas.
Cystectomy of the bladder
Cystectomy is performed in several successive stages. The first step is general anesthesia. For convenient access to the bladder, the patient must be in a special position. The patient is placed on his back, the pelvis is raised by 45 degrees compared to the head and foot ends. The incision is made along the midline. It begins in the region of the pubic symphysis and ends 2-3 cm above the umbilical ring. The first stage of cystectomy is the diversion of urine and the creation of conditions for its outflow (derivation). After that, the organ is extirpated. The amount of surgical intervention depends on the extent of the tumor. Often, in addition to the bladder, nearby lymph nodes and other organs are removed. In women, this is the anterior wall of the vagina, the urethra. With a pronounced infiltrative growth of the tumor, the uterus and ovaries are extirpated. In men, in addition to the bladder, it is often necessary to remove the prostate gland and seminal vesicles. Considering that massive blood loss occurs during the operation, cystectomy has a number of contraindications.
After diverting urine to the anterior abdominal wall or the intestines, the organ is separated from the peritoneum, the bleeding vessels are ligated and removed. Next, electrocoagulation and spinal anesthesia are performed to reduce pain in the first hours after the manipulation. It should be noted that between 1 and 2 stages of surgical intervention should take from 4 to 6weeks.
Recovery after surgery
After a cystectomy, rehabilitation can take a long time. This is due not only to the physiological changes occurring in the body, but also to the psychological state of the patient. After all, in addition to the fact that the normal process of urination is disturbed, other functional changes are noted. Recovery of the body does not occur immediately. On the first day after surgery, the patient should be in the intensive care unit. This is necessary in order to monitor vital signs, not to miss the development of bleeding and shock. When the patient is transferred to the general ward, he can already move independently. It is recommended to walk as much as possible so that the adhesive process does not develop in the small pelvis. In some cases, patients have to take food with a probe for a long time. Nevertheless, over time, the work of the intestine is restored, and the patient begins to eat on his own. Urination also gradually returns to normal. However, patients have to walk with a catheter all the time. Therefore, some patients undergo another operation - the creation of an artificial bladder. Such manipulation is performed after a few months in the absence of contraindications.
Tooth cystectomy: stages of implementation
Tooth cyst removal is also called a cystectomy. This operation is carried out in a dental office. To perform it, general anesthesia is not needed, only local anesthesia is enough. Children may be an exception. Cystectomy of the tooth involves the complete removal of the contents from the cyst membranes. Operation steps include:
- Preparation of the mucoperiosteal flap using an incision. Then it is peeled off.
- Obtaining a bone plate in order to gain access to the cyst. To do this, several holes are drilled over the formation.
- Removing the cyst and part of the root of the tooth.
- Revision of the resulting cavity.
- Suturing the mucoperiosteal flap.
Most often, a cyst is a congenital malformation of epithelial tissue. Less commonly, it appears due to long-term inflammatory processes, inadequately performed dental procedures.
Ovarian cystectomy
Ovarian cystectomy is an operation that is necessary for large cysts that are not amenable to conservative therapy. This benign formation is dangerous because it can lead to apoplexy - organ rupture. The operation to remove the cyst is carried out both in an open way and with the help of laparoscopy. The contents of the formation are sent for cytological examination. If no malignant cells are found, the ovary is coagulated and sutured.
Technique for performing cystectomy of cysts of internal organs
Cystectomy of cysts of other internal organs is carried out in a similar way. Complex operations include the removal of formations of the pancreas, lungs, liver. Such interventions are performed by an open surgical method under the generalanesthesia.
Contraindications for cystectomy
Contraindications for removal of cystic formations include:
- Acute and chronic insufficiency of the heart, kidneys, respiratory organs, which is in the stage of decompensation.
- Purulent inflammatory processes in the pelvis, abdominal and chest cavity.
- Immersion of the tooth root into the cyst by more than a third.
- Poor cytology result. In these cases, other methods of surgical treatment are required.
Reviews of doctors about cystectomy
Most doctors of various speci alties believe that cystectomy is considered a necessary surgical intervention, as it prevents the development of severe complications (peritonitis, sepsis). Often, this procedure does not pose a risk to he alth and is performed laparoscopically.
Removal of the bladder, according to doctors, is a serious and traumatic operation, accompanied by a risk of complications. However, in malignant tumors, it is considered necessary.