right hemicolectomy

The right colon resection range, if the cecum and ascending colon cancer, the ileum end 15cm, cecum, ascending colon, right half of the transverse colon and part of the greater omentum and gastric retinal vessels should be removed, and the ileocecal artery and right colon should be cut and resected. The right branch of the artery, the middle colon, and its accompanying lymph nodes. The surgical feature of treating right colon cancer is to prevent the spread of cancer cells. Therefore, the lymphatic and vascular stems of the diseased colon should be cut off first, the mesentery should be extensively removed, and the cecum and ascending colon should be released. In the treatment of benign lesions in the ileocecal area, in order to facilitate surgery, the cecum and ascending colon can be released first, and the mesentery is not removed too much. Treatment of diseases: sigmoid colon torsion Indication 1. Serious injury to the cecum or ascending colon. 2. Malignant tumors of the cecum, ascending colon or colonic hepatic flexure, and no distant metastasis. 3. ileocecal tuberculosis with partial intestinal obstruction by non-surgical therapy. 4. The ileo-type intussusception can not be reset with intestinal necrosis. 5. Others: cecal torsion, chronic inflammatory granuloma in ileocecal area, chronic localized enteritis. Preoperative preparation 1. Patients often have anemia and hypoproteinemia, which should be improved as much as possible before surgery. 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. Diet: 3 to 5 days before surgery into the semi-liquid diet, 1 to 2 days before surgery into the clear stream. 4. Oral laxative: 30 ml of 25% magnesium sulfate or 30 ml of castor oil per day for 3 days before surgery. 5. Mechanical intestinal lavage: 3 days before surgery, saline enema 1 time per night, clean enema before surgery. 6. Oral antibiotics: one of the following options can be selected: 1 neomycin 1g, erythromycin 0.5g, 1 time before surgery, 1st 8th, 14th, 18th, 22nd, 1 time. 2 kanamycin 1g, metronidazole 0.4g, 3d before surgery, 3 times / d. 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. 7. Other drugs: vitamin K4 ~ 8mg, 4 times / day. Note that water and electrolyte balance. If necessary, enter an appropriate amount of water and electrolyte solution intravenously 1 day before surgery. In order to avoid insufficient nutrient supply during colon preparation, the elemental diet can be used to replace semi-liquid and whole-flow foods. The elemental diet itself can cause mild diarrhea, so laxatives should be reduced or not given. If the factor diet is about 1 week, oral laxatives and intestinal lavage can be dispensed with, but antibiotics and vitamin K are still needed. 6. Total gastrointestinal lavage: Before the operation, the Chinese food was given to the food, and the whole gastrointestinal lavage was started 3 hours after the lunch. The lavage fluid is an isotonic electrolyte solution or a solution prepared by adding 1000 ml of warm water with 6 g of sodium chloride, 2.5 g of sodium hydrogencarbonate, and 0.75 g of potassium chloride, and injecting or orally through a gastric tube, and injecting 2000 to 3000 ml per hour. Until the liquid discharged from the anus is clean and free of dung. The advantage of this method is that it is fast, effective and free from hunger. The disadvantage is that it is easy to cause abdominal distension, which can cause sodium and water retention, so heart, liver and kidney dysfunction should not be applied. 7. 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. 8. In the left hemi-colectomy, the indwelling catheter should be placed before surgery. 9. Place the gastrointestinal decompression tube on the morning of the operation. Surgical procedure 1. The right middle abdomen is inserted through the rectus abdominis or the median midline. After entering the abdomen, explore the nature and extent of the lesion. If you have cancer, you must also pay attention to whether there is distant metastasis, especially to carefully palpate the liver with or without metastases. When the right colon is removed, push the small intestine and omentum to the left and protect with a warm saline gauze pad. In the right segment of the transverse colon and the ileum at a distance of 20 cm from the cecum, a hemostatic forceps was used to pass through the avascular region of the transverse colon and the small mesentery, each with a gauze strip, respectively ligated to block the proximal and distal ends of the diseased intestine. After ligation, fluorouracil was injected into the small intestine and colon isolation cavity, and the total dose was calculated as 30 mg/kg body weight, which can reduce postoperative liver metastasis. Then the right part of the mesenteric membrane is revealed, the colonic roots are separated, ligated and cut off, and the colonic right venous, venous, ileal, venous, and colonic right iliac veins are ligated, and the vascular end must be ligated. Road. 2. Then push the ascending colon and the cecum to the medial side, and cut the peritoneum to the hepatic flexure after cutting the lateral margin, and cut the ligament of the liver and anterior anterior. The part of the greater omentum on the right side is then cut along the upper edge of the transverse colon. 3. Use the stripper or finger to bluntly separate the retroperitoneal fat and lymphoid tissue to the root of the mesentery. During the separation process, be careful not to damage the ureter, spermatic vessels (or ovarian blood vessels) and duodenal descending and horizontal parts. 4. Completely cut the mesentery of the right colon, place a toothed hemostat and a set of intestinal forceps on the ileum 10-15 cm from the ileocecal area, cut the intestine between the two clamps, and cut it slightly when cutting. Increase the diameter of the ileum. Then cut the right end of the transverse colon in the same way and remove the right colon. 5. Lift the terminal ileum in a clockwise direction and close the transverse colon to make a contralateral anastomosis. First make a needle pull line on the upper and lower edges of the two intestines. A full-layer continuous suture was made on the posterior wall of the anastomosis with a 3-0 chrome gut. 6. Use a gut to make a full-thick continuous inversion suture on the anterior wall of the anastomosis. The suture points are the same as the gastrointestinal anastomosis. 7. Then use a thin non-absorbent line to make a row of sutures in the anterior and posterior walls of the anastomosis. 8. After the anastomosis is completed, the ileum and transverse mesenteric membranes are sutured intermittently with a fine non-absorbent line, and then the surgical field is washed with warm saline. After suctioning, the abdominal wall incision is closed according to the layer. 9. Anastomosis of the ileum and the transverse colon Sometimes end-to-side anastomosis can also be used due to the inconsistent port diameters of the two intestines, but the colon stump cannot remain too long after anastomosis. That is, the transverse end of the transverse colon is firstly closed. On the colonic band near the closed end, a longitudinal incision is made in the direction of the intestine axis, which is consistent with the diameter of the ileum, and then the end of the ileum and the transverse colon are end-to-side anastomosis. The anastomosis was performed in two layers. The inner layer was sutured in a full-thickness inversion with a 3-0 chrome gut, and the outer layer was sutured with a fine non-absorbable line. The ileum and transverse colon mesenteric sutures were interrupted by fine non-absorbent lines. complication 1. Anastomotic fistula, if the suture technique is perfect, it is caused by excessive flatulence or mesenteric vascular ligation. The former and intestinal paralysis exist simultaneously, not easy to detect; the latter clinical manifestations are clear, mainly for the performance of advanced peritonitis. If the abdominal inflammation is obvious and the scope is wide, open drainage should be performed; if the inflammation is limited, a few needles can be removed from the incision suture, placed in the drainage, and treated with non-surgical treatment. 2. Anastomotic stenosis: mild stenosis, no special treatment, due to the expansion of feces, most of them can be relieved. Severe stenosis requires surgery.