Transperineal sacrococcygeal teratoma resection

Transsphenoidal teratoma resection of the perineal region for the surgical treatment of the teratoma of the appendix. Teratoma often occurs in the appendix, and more than the newborn, more women than men, the ratio of male to female is about 1:20. According to the main site of the tumor, the teratoma of the appendix can be divided into 3 types: 1 phenotype: almost all tumors are in vitro, bulging in the tail; 2 invisible: the tumor is located between the rectum and the tibia, and develops in the pelvic cavity. Compression of the rectum and urethra, but not to the buttocks; 3 mixed type: the tumor grows into the buttocks and pelvis, between the rectum and the tibia, pushing the rectum forward, the tailbone leaning backwards and surrounded by the tumor. This classification can distinguish clinical features, and has practical significance for surgical selection and estimation of prognosis. The teratoma of the appendix is mostly benign, but there is a risk of malignant transformation. The cystic person is not easy to malignant, the substantial malignant rate is high, and the malignant rate increases with age. Recently, there have been many reports of neonatal malignant teratoma. The malignant rate of the invisible and mixed type is higher than that of the dominant type. Once the tumor has undergone malignant transformation, it can be transferred to the retroperitoneal lymph nodes along the lymph and blood, and metastasized to the lungs and bones. The whole body condition deteriorates rapidly, and the dyscrasia occurs, and soon it dies. A small tumor located below the 4th atlas can be resected by the appendix, and the tumor located above the 4th vertebrae and protruding into the abdominal cavity can be combined with a common abdominal hernia. If recurrence after resection, it can be re-excised. Treatment of diseases: teratoma of the appendix Indication The perineal tibial teratoma resection is applicable to: 1. Significant appendix teratoma. 2. For those who have or will have complications, such as obstruction and urinary retention, cyst rupture or thin wall and ulcer, necrosis or infection trend, emergency surgery should be performed. Contraindications If there is an infection, the infection should be properly controlled before surgery. Preoperative preparation 1. When the tumor is infected, antibiotics should be applied before surgery. 2. Thoroughly clean the enema and take neomycin and erythromycin for gastrointestinal preparation. 3. Prepare blood before surgery and prepare for blood transfusion. 4. If the tumor is huge, the catheter should be indwelled. Surgical procedure Incision Use an inverted V-shaped incision with the tip up and the sides of the incision extending to the outside of the buttocks. The length depends on the size of the tumor. 2. Isolation of tumor After flipping the flap, the subcutaneous tissue is cut and the correct dividing line is found outside the intrinsic capsule of the tumor for sharp or blunt separation. Keep your hip muscles as much as possible. If the tumor is small, first ligature, cut off the blood vessels that go to the tumor, and then separate the tissue surrounding the tumor, which can reduce blood transfer. The sacral blood vessels that supply the tumor are cut off after ligation, and the tumor and the appendix are closely adhered to remove the adhered coccyx, and if necessary, the 4th to 5th vertebrae are removed. 3. Prevent damage to the posterior wall of the rectum The operator or assistant puts a finger into the rectum as a marker to determine the position of the rectum. First, carefully separate a gap between the tumor and the rectum, and then separate along the gap to avoid damage to the rectum. When the tumor and the rectum are not easily separated, it is better to leave part of the tumor, and do not force the separation to break the rectum and contaminate the wound. Once a rectal rupture occurs, it should be repaired immediately. 4. Remove the tumor Check whether the resected tumor is intact. If necessary, make a rapid pathological examination of the basal tissue to determine the presence or absence of tumor tissue. Sutures should be repaired when the pelvic peritoneum is damaged. Carefully ligature the bleeding point. Eliminate the dead space left after tumor resection. The smoke is drained at the bottom of the wound. Intermittent suture of anterior fascia, subcutaneous tissue and skin complication 1. Wound infection should continue to apply antibacterial drugs and prevent large and urinary contamination of the wound. When the infection is severe, the wound should be fully drained. 2. Anal incontinence or urinary retention: due to injury to the anterior tibial nerve or anal sphincter, during surgery should be vigilant. 3. Long-term unhealed wounds or leftover fistula: If residual tumor tissue is caused, all tumors should be surgically removed.