ileal single-port ostomy

The ileal (end) single-mouth ostomy is a permanent or temporary complete ostomy. Treatment of diseases: chronic ulcerative colitis Indication 1. Chronic extensive ulcerative colitis patients, can not tolerate the first stage of colon resection, can be used for ileal fistula, until the condition improves, and then resection. 2. As a step before or during intraoperative colectomy for multiple colon polyposis. 3. Patients with severe acute colon obstruction are used to temporarily relieve intestinal obstruction. Contraindications The patient is too old and should be filled with poor general condition. Preoperative preparation Most patients are in poor condition and must be fully prepared before surgery. 1. Infusion, blood transfusion, correction of dehydration, acidosis and low plasma protein. 2. Intramuscular injection of vitamins b1, c, k. 3. Actively control infection and rational use of antibiotics. 4. Patients with intestinal obstruction or stomach or duodenal fistula should be placed with gastrointestinal decompression tube before operation. Surgical procedure 1. Position: supine position. 2. Incision: a midline incision in the left lower abdomen. 3. Cut the end of the ileum and close the distal ileum: Lift the end of the ileum to the outside of the incision. At a distance of about 15 cm from the ileocecal valve, select a vascular bow that can supply the blood vessels to the proximal and distal intestines. Cut off. From the vicinity of the intestinal wall to the root of the mesentery, the mesenteric membrane is separated and the bleeding point is ligated. The ileum of the mesenteric septum was clamped with two duodenal forceps and the ileum was cut between the two clamps. The proximal ileum is temporarily protected by a condom or a rubber membrane and tied with gauze strips. The distal ileum was sutured with a thin wire for continuous suture, and the muscle layer was sutured to seal. 4. Proximal ileal fistula: The position of the ileum on the abdominal wall should be selected before surgery, and a mark on the skin with gentian violet. Generally, the right lower abdomen is equivalent to the inner side of the midpoint of the umbilical cord and the anterior superior iliac spine. It is not allowed to overlap with the umbilicus when wearing the artificial anal pocket after surgery. At the fistula, make a fusiform or circular incision equal in diameter to the ileum (the incision should be able to accommodate two fingers and not tight), remove the skin, the external oblique aponeurosis and the rectus abdominis anterior sheath, and cut the abdominal wall. Muscle and peritoneum. The proximal ileum with the condom is taken out of the incision by about 6 cm, so that the mesentery has no tension. The free edge of the mesentery is sutured into the peritoneal wall of the anterior abdominal wall in the abdominal cavity to prevent internal hemorrhoids. The ends of the ileum are aligned to prevent intestinal prolapse after surgery. The ileum membrane was sutured with a small incision peritoneum. The condom of the proximal ileum is removed, the mucosa of the intestine wall is eversioned, and the outer wall of the ileum is sheathed, and the skin of the eversion of the mucosa and the skin of the small incision are sutured with a thin thread. One of the needles needs to pass through the skin, the mesentery and the mucous membranes to secure the valgus mucosa. The ostomy is wrapped in Vaseline gauze. 5. Stitching: suture the abdominal wall incision layer by layer. complication Diarrhea or intestinal cramps.