Loop double-lumen colostomy

Colostomy can be divided into temporary and permanent, in which the temporary stoma is often double-mouth stoma, and the permanent stoma is often treated with colon single-chamber stoma. The location of the stoma is selected in the transverse colon or sigmoid colon. In a few cases, the stoma is selected in the cecum. Treatment of diseases: colonic anal atresia Indication 1. In the case of high rectal anal atresia, in order to ensure the success of radical surgery, it is often necessary to perform sigmoid colostomy or transverse colostomy before surgery. 2. Immature children or other malformed anal sick children with other systems should first make a colostomy, and then do a rectal anusplasty after the situation improves. 3. Congenital anus, the sick child is seriously ill with severe malnutrition or aspiration pneumonia. 4. Insufficient equipment and technical conditions, if there is not enough grasp for radical surgery without anus, in order to save the lives of sick children, colostomy can be performed first, and then transferred to a specialist hospital for treatment. 5. Some scholars advocate that colostomy should be chosen for congenital megacolon, and it is safer to perform radical surgery after 3 months. Or congenital megacolon combined with enteritis, high malnutrition can not tolerate radical surgery; congenital long segment of the giant colon before surgery to clean the intestine difficult, should also be a colostomy. Colostomy of the congenital megacolon is generally selected at the proximal end of the dilated bowel. Do not make a stoma in the dilated bowel near the sacral section, because sometimes the ganglion cells in the intestine are also missing or denatured, causing the stoma to fail. When there is no ganglion cell in the whole colon, the stoma should be selected at the end of the ileum. Before the stoma, a cryosection should be performed to confirm that the ganglion cells can be normal. 6. Newborn colonic atresia, critically ill can not be performed with intestinal resection and anastomosis, should first do a colon double cavity stoma, in order to quickly remove the obstruction and improve the general situation. 7. Colonic injury or perforation or rectal anal injury, while repairing the injury, colostomy is required to ensure the healing of the repaired site. Preoperative preparation There are many bacteria in the colon, which may cause infection in the abdominal cavity or incision after surgery. Therefore, in addition to emergency stoma, it is generally necessary to prepare for intestinal cleansing. 1. Preoperative barium enema, rectal manometry, rectal mucosal biopsy, cholinesterase determination, clear diagnosis and understanding of the extent of the lesion. 2. Preoperative blood and urine routine examination, liver and kidney function and electrocardiogram examination. 3. Prepare the bowel before surgery for colonic lavage with normal saline 3 weeks before surgery to remove the feces in the colon, relieve abdominal distension, restore intestinal tract, reduce symptoms of poisoning, improve nutritional status, and treat enteritis. The condition of the sick child is gradually improved, and the enema effectively relieves the functional colonic obstruction, so that the partially dilated bowel gradually returns to normal, which facilitates the scope of the resection in the operation. In colonic lavage should pay attention to: 1 must use isotonic saline, because low permeability liquid is easy to cause water poisoning, high permeability liquid is easy to cause salt poisoning. The most important thing is to accurately measure the amount of enema in and out, to prevent the instilled saline from staying in the intestine. The total amount of enema per time must not exceed 100ml/kg body weight. 2 enema should choose soft, but slightly thicker anal canal, easy to excrete feces from the anal canal. The enema should understand the extent and direction of the diseased bowel, and the tube should be gentle. Each time the enema is administered, the anal canal is passed through the sacral section to reach the dilatation section. Do not inject too much liquid each time, pour a certain amount of salt water, gently massage the abdomen, and squeeze the expansion section downwards, so that the gas, feces and liquid in the intestinal tract are discharged from the anal canal. After the daily enema, the purpose of cleaning the expansion section should be achieved. 3 In the winter enema, you should keep warm to prevent cold and respiratory infections. 4 For children with short sputum, you can pour "123 liquid" (ie 33% magnesium sulfate 30ml, glycerol 60ml, normal saline 90ml) before washing with normal saline. Infants can be half-infused, stimulate bowel movements, and then cleanse the intestines with saline. 4. If there is water and electrolyte disturbance, it should be corrected in time. Anemia can be transfused in small amounts. 5. Give low slag, easy to digest, high protein, high vitamin food during enema, give high nutrition in the intestine if necessary, actively improve malnutrition, and improve the body resistance of sick children. 6. Give intestinal sterilizing agent 3 days before surgery to reduce bacteria in the intestine and reduce the infection rate after surgery. 7. Preoperative blood. 8. Place the stomach tube before surgery, and place the catheter after disinfection in the operation area. Surgical procedure 1. After opening the abdomen, the colon to be prepared for stoma is placed in the abdominal cavity, and the corresponding mesenteric is selected to be an avascular region, and then gradually expanded to allow a glass rod to pass. 2. The glass rod is passed through the mesenteric orifice, and then the distal and proximal colon serosal layers of the stoma are sutured intermittently with the peritoneum, fascia and skin. In order to prevent the intestinal tube from escaping after surgery. 3. The incision is sutured, and the intestine is wrapped with iodophor gauze to promote adhesion of the intestine to the skin as soon as possible. The intestine is covered with Vaseline gauze. 4. Remove the glass rod 48 hours after surgery and cut it with the electric knife along the direction of the colon. Intestinal mucosal valgus completes the colostomy. This type of ostomy is connected to the posterior wall of the colon between the distal and distal ends, so it is called a double-chamber ostomy. complication 1. Intra-abdominal and wound infection Because colostomy is a bacteriological operation, and sometimes it is urgently performed without bowel preparation, there are more opportunities to contaminate the abdominal cavity and incision. Therefore, if it is possible to do preoperative bowel preparation as much as possible, cases that cannot be prepared for intestinal tract should also properly protect the abdominal cavity and the incision from contamination. After the intestine can be cut, it can be disinfected by neostigmine or iodophor. Antibiotics are used to prevent infection after surgery. 2. Ostomy tube prolapse It is common to suture the layers of the abdominal wall between the stoma, causing the mouth of the stoma tube to be too large, which may cause prolapse with peristalsis. The prevention method is that the suture of the stoma and the abdominal wall should be sutured tightly, not too loose, and only a small finger is reserved. 3. Stoma It is caused by the tightness of the abdominal wall of the suture. When the stoma is too tight, the intestines at the stoma will have severe edema and may even cause circulatory disturbance. In the long-term, it causes export obstruction, difficulty in defecation, and even expands the proximal colon of the stoma to form fecal stone. Once the above conditions are discovered, the treatment should be expanded early. 4. Stoma retraction Pull out the intestines to have sufficient length. If the freeness is not enough, pull out the intestines and have tension. After the retraction, the feces discharged from the stoma can be directly impregnated into the abdominal wall to make the abdominal wall smash, making the nursing of the pseudo anus difficult.