Rectal stricture plastic surgery

Rectal stenosis is a rectal dissection for rectal stenosis. Treatment of diseases: congenital anorectal stenosis Indication 1. Low-position combined with rectal scaphoid fossa, rectal skin spasm, thick fistula and anal stenosis can be expanded first, and then the operation time and surgical procedure are determined according to the situation. 2. If the low-grade innocent tube or fistula is extremely thin, rectal stenosis should be performed as soon as possible. 3. The median type can be performed with a double-hole ostomy of the transverse colon. After 3-6 months, the anastomosis can be performed after the sagittal approach, and the perineal anal angioplasty can also be performed in one stage. 4. High-grade patients should consider the first transverse colon double-hole ostomy. After 3 to 6 months, the anastomosis of the anastomosis was performed after the sagittal approach. A small number of epidural perineal angioplasty can be performed in one stage. Abdominal perineal anal angioplasty has been used sparingly. Contraindications Unstable vital signs. Surgical procedure 1. Low-grade type: The operation is performed under local anesthesia, castor or general anesthesia. (1) perineal analplasty 1 male baby is placed in the catheter, the baby girl has a small anal canal in the vagina, and a "+" or "x" incision is made in the anal crypt, about 1.5cm long. 2 Cut the skin and subcutaneous tissue, free the flap to retract around, use the electroacupuncture to find the center of the external sphincter, bluntly separate the muscles, and separate the deep rectum to find the rectal blind end and free enough length. 3 The rectal blind end or the anal membrane is cut into "X" or "+" shape, and the incision flap is turned open to the periphery, and the skin incision gap is sequentially inserted, and the whole layer is intermittently sutured. 4 postoperative treatment: rectal built-in Vaseline iodoform gauze to stop bleeding. Anal expansion was started 2 weeks after surgery, 1/d. After 3 months, every other day or 1/3d, lasts for half a year. (2) Anal advancement with stenosis: the skin is inverted from the posterior edge of the anus to the tailbone. The flap was inserted into the posterior wall of the distal rectum, which was longitudinally incised, and sutured intermittently. Postoperative treatment is the same as above. (3) rectal vestibular fistula: as appropriate, use a simpler peeling along the fistula and then transfer to the anus "X" or "+" incision, suture fixed 2 layers. You can also choose anal rectal prosthesis with perineal or even sagittal approach. 2. Median type: Anorectal or anastomosing can be used as appropriate. 3. High position: The posterior sagittal approach anorectalplasty (PSARP, Pena surgery) is preferred. (1) Surgery is performed under general anesthesia and tracheal intubation. The hip was prone and the Foley catheter was inserted before surgery. (2) posterior median sagittal incision, 2 cm above the tip of the tailbone, and 1~1.2 cm from the leading edge of the anal crypt. Under the monitoring of the electro-acupuncture instrument, the deep incision is performed, and the muscle groups are divided into two sides at opposite positions. It is often necessary to cut the coccyx for good exposure. (3) The rectum of the ridge can often be seen in the front of the sputum. The traction line assists in fully relaxing the rectum to the rear and sides, and then to the front, until it is long enough. (4) The incision can be exposed by cutting the near end of the posterior wall of the rectum. Cut around the ankle and separate the rectal urethral space, try to avoid damage to the urethra. (5) Ligation or suturing 2 layers of urethral fistula with 5-0 absorbable suture, and surrounding tissue is embedded. Pay attention to the length of the residual fistula to prevent urethral stricture or diverticulum. If the rectum is too thick, it should be cut and then shaped. (6) Following the electric stimulator to determine the front boundary of the external sphincter and levator ani muscle. (7) The rectum after the tailoring and suturing is placed in the symmetrically incision muscle group, and the muscle layer of the rectum and the posterior rectum are sutured intermittently, layer by layer, and symmetrically, and completely repaired. The suture should pass through part of the rectal wall and be fixed to the surrounding tissue. (8) The distal rectal muscle layer is subcutaneously sutured with the subcutaneous and rectal layers and the skin. Stitch the incision in front of the anus. The posterior sagittal incision was sutured layer by layer.