left hemicolectomy

Left hemicolectomy is a surgical procedure for the treatment of colon cancer. Resection range: the left segment of the transverse colon, the spleen of the colon, the descending colon, and the right segment of the transverse colon is anastomosed to the proximal end of the rectum. For the descending colon or sigmoid colon, the inferior mesenteric artery should be separated from the vein, ligated and cut off, along the abdominal aorta. Clear lymph nodes from top to bottom. Indications: 1. Colon cancer or sigmoid colon cancer. 2. Colonic and sigmoid colon ulcerative colitis or multiple polyps. 3. Sigmoid colon or descending colonic diverticulitis complicated with obstruction. 4. Sigmoid colon torsion necrosis or stenosis. Anesthesia with right hemicolectomy. Treatment of diseases: colonic rupture, colonic lipoma, colon cancer, preoperative preparation 1. Patients often have anemia and hypoproteinemia, which should be improved as much as possible before surgery. Give a diet rich in nutrients and less slag, use fluid before the operation, and transfuse blood or plasma if necessary. 2. Pay attention to check the function of vital organs such as heart, lung, liver and kidney, coagulation mechanism and whether there is distant metastasis. 3. Prepare the intestines for 3 to 5 days, including: (1) If you have constipation, you can start using laxatives when you are admitted to the hospital. (2) From the 3rd day before surgery, mannitol is administered orally or enema once a night, and the enema is cleaned before surgery. (3) Oral antibiotics such as sulfa drugs and metronidazole from 3 to 5 days before surgery (adding neomycin to oral sulfa drugs 24 hours before surgery, 2 g each time, once every 6 hours). Kanamycin has no obvious stimulation to the gastrointestinal tract, is not easy to cause diarrhea, and is superior to neomycin. Oral administration was started 72 hours before surgery, 1 time per hour, 1 g each time, and even 4 times, and every 6 hours thereafter, 1 g each time before surgery. For elderly, infirm, and antibiotics before and after surgery, you can take nystatin 3 times a day, each time 1 million U, to inhibit mold growth. Oral gut antibiotics should be given vitamin K at the same time. 4. In patients with left colon cancer complicated with acute obstruction, the risk of primary resection is high. Generally, the right transverse colonic fistula should be used first. After 2 to 3 weeks of decompression and preparation, radical surgery is performed. For side colon cancer, one-stage surgery is feasible, but if the condition is severe and the obstruction is severe, it should be used for cecal or colostomy. 5. In the left hemi-colectomy, the indwelling catheter should be placed before surgery. 6. Place the gastrointestinal decompression tube on the morning of the operation. Surgical procedure 1. Position: supine position. 2. Incision: The right side of the left side of the incision. 3. Exploration: Explore the nature, size and activity of the left colon lesion, as well as lymph nodes, liver, pelvic lesions. 4. Expose the left colon: Protect the large intestine and the greater omentum with a warm saline gauze pad, and pull it open to the midline with a deep hook to reveal the left colon. 5. Ligation of mesenteric vessels: the peritoneum was cut under the duodenal suspensory ligament, the inferior mesenteric artery was separated from the vein, ligated and cut, and the proximal end was ligated and sutured. The lymph nodes were removed from top to bottom along the abdominal aorta. At the upper and lower ends of the tumor about 5 to 6 cm away, the gauze strip is passed through the mesentery at the edge of the intestinal wall to tighten the intestinal lumen, and the intestinal contents of the tumor are controlled to avoid up and down flow, resulting in dissemination. 6. Separation of the left colon: the peritoneum was removed after the left margin of the descending colon, and the left colon and mesentery were pushed away from the midline by blunt and sharp separation. When separating the left mesenteric membrane and revealing the left posterior abdominal wall, care should be taken to avoid damage to the left kidney and ureter. The spleen colon ligament was incised and the spleen of the colon was isolated; the left part of the gastric collateral ligament was incised and the left segment of the transverse colon was isolated. Care should be taken to avoid damage to the left kidney, spleen and pancreatic tail. The peritoneum of both sides of the pelvic sigmoid colon was cut open to separate the sigmoid colon. Take care to avoid damage to the bladder and the ureters on both sides. Then, the left colon mesal is separated, clamped, cut, and sutured. In the middle of the transverse colon, two duodenal forceps (or full-tooth straight hemostats) were placed side by side and then cut; the ends of the sigmoid colon were clamped with two right angle clamps and then cut off to remove the left colon. 7. Transverse rectal anastomosis: remove the margin of the preserved end of the intestine wall, the intestine is wiped with red mercury gauze, and then the right side of the transverse colon is anastomosed to the proximal end of the rectum (usually open end-to-end anastomosis) . The right segment of the transverse colon should be separated and relaxed as much as possible, and the proximal end of the rectum should be kept long enough to ensure that the anastomosis is tension-free. First fix with a two-needle pull line and then anastomosis. The outer layer of the posterior wall was sutured with a thin wire as a sarcolemma, and the inner layer was sutured with a silk thread (or 2-0 chrome gut) for full-thickness suture. The inner layer of the anterior wall is sutured with a full-thickness inversion of the silk thread (or 2-0 chrome gut), and the outer layer is sutured with a silk thread as a sarcolemma. 8. Closed pelvic peritoneum: Firstly, the peritoneum separated from the pelvic cavity was sutured with a thin thread, and the pelvic peritoneum was closed to cover the anastomosis; then, the right transverse mesenteric membrane and the posterior peritoneum were sutured with a thin thread. A cigarette drainage was placed in the pelvis near the anastomosis and was withdrawn from the abdominal wall incision. 9. Stitching: suture the abdominal wall layer by layer.