Colorectal resection and external anastomosis

The advantage of this operation is that the lower rectum is preserved, and normal bowel reflex can be observed after operation; the colon and rectum are anastomosed outside the anus, and the operation is convenient, and the intra-abdominal infection can be avoided. The main disadvantage is that the tissue damage is large, the pelvic nerve plexus is easily destroyed, resulting in postoperative bladder paralysis, and easy to occur anastomotic leakage and stenosis, and the mortality rate is high. Treatment of diseases: colonic leiomyoma anal canal, rectum, colon stenosis Indication X-ray examination of congenital megacolon confirmed the sigmoid colon and rectal segment. The newborn is over 6 months old and is generally in good condition. Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation 1. Admitted 4 weeks before surgery, less slag diet, daily oral liquid paraffin 60ml, enema 1 or 2 times. 2. Oral administration of succinyl sulfonamide and other drugs 2 weeks before surgery. Such as combined with colitis, repeated diarrhea, can be repeated with normal saline irrigation, 3 times a day, and oral neomycin 50mg ~ 100mg / kg · d, 3 to 4 times orally. 3. If the proper colon preparation, the fecal condition has not improved, should consider the first transverse colon fistula. After ostomy, the sigmoid rectal segment is usually removed 3 to 6 weeks later. 4. Intravenous infusion, correct water and electrolyte imbalance; small, multiple blood transfusions, improve malnutrition, anemia, and strengthen surgical tolerance. 5. A detailed examination of the urinary system; pay attention to whether the sick child has combined with upper respiratory tract infection, pneumonia and other diseases, if any, timely treatment. 6. An anal canal can be inserted 48 hours before surgery and enema 3 times a day. The enema must be treated with normal saline, avoiding the use of clear water. As a large amount of water is quickly absorbed into the circulatory system from the broad intestinal mucosa, water poisoning may occur, leading to heart failure and death. That is, using a saline enema, the weight per kilogram should not exceed 100 ml. After the above preparations, there should be no feces in the colon and a boat in the abdomen, and surgery can be performed. 7. Lower stomach tube on the surgery day. 8. Prepare blood and blood with 400ml. 9. When necessary, prepare for frozen section inspection. Surgical procedure 1. Position: put the child lying on the large plate, the buttocks are high, the perineum is placed on the edge of the large plate, which is convenient for the operation of the perineum. The upper and lower limbs are fixed on the large plate and the left iliac vein is cut. Open, the right lower limb is not fixed, so as to facilitate the movement of the perineal operation. Place the indwelling catheter. 2. Incision: The left lower right side of the incision, from 1cm on the umbilicus to the upper edge of the pubis, length 6 ~ 7cm. 3. Abdominal exploration: After entering the abdominal cavity, the sigmoid colon is inspected outside the incision, and the dilated sigmoid colon is gradually divided into a narrow rectal segment, which is a segmental intestine with no ganglion. The intestines above the sacral section are expanded second, the intestinal wall is thick, pale, tarnished, the colonic band is sparse, and the intestines lose their peristaltic function, usually turning to the upper part of the descending colon. The above abnormal intestinal fistula should be completely removed. 4. Separation of the rectum and sigmoid mesentery: incision of the sigmoid mesentery and the rectum on both sides of the rectum and the rectal bladder fossa, taking care not to damage the ureters on both sides. In order to make the sigmoid colon fully active, the sigmoid colon should be cut off, and the ligation and cutting should be close to the starting point of the artery, so that the vascular arch can be preserved and the intestinal wall can be fully transported. The trunk and branches of the left colonic artery are preserved to ensure blood supply to the proximal colon. If you need to remove most of the descending colon, you sometimes need to cut the left colon. Separated in the upper part of the rectum, reaching the level of the levator ani muscle at the bottom of the basin. In order to avoid damage to the bladder nerve, the rectum should be separated as close as possible to the intestinal wall. The upper and middle iliac arteries encountered during the anatomy need to be ligated and cut. 5. Excision of the sigmoid colon rectum, temporary suture of the stump to remove the huge sigmoid colon and rectal stenosis. When there are conditions, the sigmoid colonic wall tissue should be taken for frozen section examination; if it is not normal, it should be removed again. First suture the proximal colonic end, and use a white line on the mesangial side, a black line on the side of the mesial (or a thin line on one side and a thin line on the other side) to prevent the bowel from being pulled out. Reversed. Then, the rectal stump was continuously sutured with a silk thread, and the muscle layer of the intermittent pulp was sutured. 6. Pull out the rectum and colon stump with a long hemostatic forceps or oval clamp 0.1% Xinjieer or thiomersal gauze ball inserted from the anus, disinfect the rectum, and use the left hand to draw the rectum from the pelvis Stump, and use the oval clamp to clamp the inner wall of the rectal stump, pull out the anus, and turn the rectum stump out to become the outer sleeve of the mucosa. The anterior wall of the rectal stump was cut transversely about 3 cm above the tooth line. Then, insert a long curved hemostatic forceps into the pelvic cavity from the incision, clamp the traction line of the proximal colon stump, and pull the proximal colon out of the anus about 4 cm, taking care not to twist the intestine. 7. Anastomosis of the rectum, colon, suture the anterior wall muscle layer of the rectum and the anterior wall of the anterior wall of the colon, and then remove the excess rectum from the anus, suture the posterior wall of the rectum and the posterior wall of the colon. . Then, the proximal wall of the proximal colon is cut open, the contents of the colon are exhausted, and the rectum and the anterior wall of the colon are sutured in a full layer. Finally, the posterior wall of the colon is cut, and the rectum and the posterior wall of the colon are sutured together until the excess colon is removed, and the colon and rectum are anastomosed outside the anus. The anastomosis is returned to the anus, and the cigarette is drained on the posterior side of the anastomosis, and is introduced through a small incision on the posterior side of the anus. After the peritoneal incision was sutured, the abdominal wall incision was closed layer by layer. complication Urinary tract complications, abdominal distension, can be placed in the anal canal. If acute enteritis occurs after surgery, it can be treated with colon flushing.