A Study On Anastomosis Of Bladder And Intestinal Canal In Animal Experiment

Objective:With the development of minimally invasive surgery and rapid rehabilitation surgery,laparoscopic radical cystectomy has gradually replaced open radical cystectomy,and gradually became the "gold standard" for the treatment of invasive bladder cancer.Laparoscopic radical cystectomy includes total cystectomy,pelvic lymphadenectomy and urinary diversion,while the rinary diversion is the key part of radical cystectomy for it is critical relation with the quality of life of patients.Compared with other ways of urinary diversion,the new bladder in situ in ileum has some advantages of low incidence of postoperative complications and obvious improvement in quality of life.It has gradually been accepted by patients and became one of the ideal ways of urinary diversion.Because of the small space behind pubic bone,the difficulty of operation and so on,the anastomosis of ileal new bladder and urethral stump is always the technical difficulty of this operation.It is always the difficulties that how to reduce the difficulty of ileal in situ neovesicourethral anastomosis,to improve the operation efficiency and ensure the quality of the anastomosis,which result in that urologists at home and abroad have been focusing lately on it and urgently hoping to solve the problems.According to the "crawling" repair of transitional epithelial cells of urinary tract,which has the physiological characteristics of fast repair,our group proposed an improved anastomotic technique of without suturing between bladder and urethra,namely "new bladder urethra dragging and kissing method".In this experiment,the rabbit was used as the research object.The transitional epithelium of bladder was closed to the glandular epithelium of intestinal tract with the support of urinary catheter.The healing of the transitional epithelium of bladder and the glandular epithelium of intestinal tract was observed.To compare the difference of operation time,anastomotic time,intraoperative blood loss,leakage of urine after anastomotic operation and healing between the two methods.The purpose of this study is to provide experimental and theoretical basis for the application of new bladder andurethra traction and anastomosis in laparoscopic radical cystectomy plus ileal neobladder in situ.method:40 Japanese big ear rabbits of 20-24 weeks old were randomly divided into two groups: experimental group and control group.The two groups of experimental rabbits were fed in the clean animal room in the same way and under the same anesthesia condition.In the experimental group,the transitional epithelium of the bladder and the glandular epithelium of the intestine were anastomosed by using the catheter as the support;in the control group,the transitional epithelium of the bladder and the glandular epithelium of the intestine were anastomosed by using the traditional intermittent suture method.The preparation before operation,the type and dosage of anesthetic during operation and the feeding mode after operation were the same in the two groups.The time of operation,the time of anastomoses between bladder and intestine,the amount of bleeding during operation,the leakage rate of urine after anastomoses and the healing of transitional epithelium of bladder and glandular epithelium of intestine were observed.Statistical software SPSS 24.0 was used to analyze the data.The operation time,anastomotic time,intraoperative bleeding volume and anastomotic healing score were measured by independent sample t-test.The incidence of postoperative anastomotic leakage was expressed by percentage(%),which was measured by chi square test.Each observation index between the two groups was statistically analyzed,and the advantages and disadvantages and effects of different anastomosis methods were compared between the two groups.result:The operation time of the experimental group was 33.3 ± 2.79 minutes,and that of the control group was 35.25 ± 1.83 minutes.The difference was statistically significant(t =-2.617,P < 0.05).The anastomotic time of bladder and intestine in the experimental group was 7.55 ± 1.24 min,and that in the control group was 8.65 ±1.03min;the anastomotic time of bladder and intestine in the experimental group was significantly shorter than that in the control group(using intermittent anastomotic method),the difference was statistically significant(t =-3.007,P < 0.01).The amountof bleeding in the experimental group was 6.47 ± 2.41 ml,while that in the control group was 6.75 ± 1.83 ml.The amount of bleeding in the experimental group was the same as that in the control group,with no significant difference(t =-0.401,P > 0.05).On the 10 th day after operation,urethrography was performed in two groups of rabbits.The results showed that the leakage rate of anastomotic orifice in experimental group and control group was 20%(2 / 10)and 11.1%(1 / 9)respectively,with no significant difference(2 = 0.882,P > 0.05).There was no significant difference between the two groups(t =-0.301,P > 0.05).Conclusion:1.We successfully constructed the animal model of bladder and bowel anastomosis in rabbits,which has the advantages of easy operation,easy observation,good repeatability,low cost and high replication rate.2.There was no significant difference in the rate of leakage of urine,the condition of healing and the amount of bleeding during the operation between the anastomotic method of non suture and dragging of bladder and intestine,but the operation time and anastomotic time were shorter.3.In the rabbit experiment,the anastomotic method of non suturing and dragging between bladder and intestine is effective,simple and feasible,and the learning curve is short,which provides the experimental basis for the clinical application of the new bladder urethra dragging and kissing method.