Transrectal muscle sheath colon extraction

This kind of operation does not pollute the abdominal cavity, and the tissue damage is small, so that the internal and external anal sphincters, levator ani muscles and visceral nerves, lumbosacral nerves and sacral nerve plexus are not damaged, so as to ensure bowel movement and urination function. However, the mucosa is easily peeled off, or complications such as pelvic inflammatory disease, rectal perforation or stenosis are caused by infection between the two layers of intestinal tract. Treatment of diseases: congenital anorectal stenosis Indication In the infants born 6-12 months, the rectal mucosa and the muscular layer are loose and easy to separate. If the non-surgical treatment is ineffective, the operation can be performed. 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, revealed: the same anastomosis with colorectal resection. 2. Separate the upper rectum: Cut the posterior peritoneum on both sides of the rectum and avoid the ureters on both sides. Lift the sigmoid colon and separate the upper rectum. 3. Circular incision of the superior rectal muscle layer: 0.5% procaine above the pelvic inlet, annular injection into the sarcoplasmic muscle at the distal end of the sigmoid colon, but do not inject into the mucosal layer. The sarcoplasmic layer of the upper rectum was cut open and the submucosa was separated downward. Using a pair of scissors and a small gauze ball soaked with adrenaline solution for sharp and blunt separation, from the proximal end of the rectum to the distal rectum, until the anus, so that the submucosa is completely exposed. Due to the hemostasis of adrenaline, there is usually not much oozing, and only a few small blood vessels need to be ligated. 4. Cut the anal canal white line: After the anus is enlarged, use 4 tissue clamps to clamp the anus white line, and open and reveal the "mucosa" inside the anus (actually the transitional epithelium above the white line). Cut the "mucosa" of the anal canal and sneak up the lower layer of the "mucosa" to communicate with the submucosa separated from the upper end of the rectum. At this point, the rectal mucosa and muscle layer have been completely separated, making the rectal wall a sheath with only the serosa and muscle layers. 5. Severing the sigmoid mesentery: Separate and cut the sigmoid mesentery, ligation of the sigmoid colon grade 2 blood vessels, and preserve the blood supply of the proximal colon. 6. Pull out the megacolon intestinal fistula and part of the proximal colon: a suture is used as a marker on the upper boundary of the colon wall to be removed, and the rectal mucosa, megacolon and proximal colon are pulled out of the anus from the rectal muscle sheath. Until the mark line is exposed. Thus, the rectal muscle sheath conforms to the serosal layer of the proximal colon, and adhesion will occur after surgery. Cut the proximal colon 5 to 10 cm from the anus, which is to remove the huge sigmoid colon and rectal mucosa. The anal canal was inserted into the proximal colon residue and fixed in a purse-seal bag. A cigarette is placed between the rectal muscle sheath and the serosal layer of the colon, and is drawn from the anus to prevent infection in the muscle sheath. Then, the muscle layer of the colonic plexus and the skin around the anus were sutured intermittently, and the rectal muscle sheath stump and the pulp muscle layer of the colon were sutured intermittently in the abdominal cavity. The peritoneum was sutured and the layers of the abdominal wall were closed. complication Anal pain.