colectomy

Commonly used colectomy in the clinic is right hemicolectomy and left hemicolectomy. According to the location, nature and size of the local lesions found in the colon, partial colonectomy or subtotal colectomy was performed. Treatment of diseases: colonic rupture and colonic atresia 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. Other cecal torsion, chronic inflammatory granuloma in ileocecal area, chronic localized enteritis. Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation 1. Patients often have anemia and hypoproteinemia, which should be improved as much as possible before surgery. Give a diet rich in nutrients and less slag, use fluid before the operation, and transfuse blood or plasma if necessary. 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. Prepare the intestines for 3 to 5 days, including: (1) If you have constipation, you can start using laxatives when you are admitted to the hospital. (2) From the 3rd day before surgery, mannitol is administered orally or enema once a night, and the enema is cleaned before surgery. (3) Oral antibiotics such as sulfa drugs and metronidazole from 3 to 5 days before surgery (adding neomycin to oral sulfa drugs 24 hours before surgery, 2 g each time, once every 6 hours). 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. 4. 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. 5. In the left hemi-colectomy, the indwelling catheter should be placed before surgery. 6. Place the gastrointestinal decompression tube on the morning of the operation. Surgical procedure 1. Abdominal transabdominal rectus or lateral median incision. 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 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 to increase The ileum breaks the port diameter. Then the transverse colon is cut by the same method and the colon is removed. 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.