sigmoid rectal resection end-to-end anastomosis

This procedure, also known as anterior rectal resection, can be performed in the abdominal cavity, omitting the operation of the perineum and not damaging the sphincter function, and the complication of the genitourinary system is less; but the anastomosis is difficult in the deep pelvic cavity. There is no serosa covering in the rectum, and anastomotic leakage is easy to occur. If the lymph nodes in the deep pelvic cavity are transferred, there is a possibility that the resection is not complete enough. Treatment of diseases: rectal polyps colon cancer Indication 1. The lower edge of the tumor is more than 12 cm above the anus and rectal sigmoid colon cancer. 2. Multiple polyps confined to the lower segment of the sigmoid colon and the upper rectum. Preoperative preparation 1. Check liver and kidney function. Patients with bladder irritation should be treated with cystoscopy to understand whether the bladder or ureter has tumor invasion. 2. Improve the general condition of the patient and give a high protein, high calorie and low slag diet. If the anemia is obvious, it is advisable to interrupt a small amount of blood transfusion to increase the hemoglobin to more than 10g%. 3. Change slag-free or less slag diet 3 days before surgery. 4. Start 24 hours before surgery, only take neomycin 0.5g, metronidazole 0.4g, once every 6 hours. 5. Clean the intestines. For patients without colonic obstruction, take oral liquid paraffin 30ml or castor oil 15ml daily for 2 days before surgery, and enema with warm saline 2000ml every night. Some patients have oral obstruction. Oral liquid paraffin 30ml per night before surgery, and pass the narrow anal canal through the narrow In the segment, a warm saline enema is injected above the tumor. Clean the enema 1 day before surgery. 6. Female patients were given a vaginal rinse daily for 2 days before surgery. 7. Place the stomach tube before surgery. 8. Place the catheter under anesthesia. If the tumor is relatively fixed, it is estimated that there may be adhesions around the tumor, and the ureter can be intubated through the cystoscope to safely separate the ureter. Surgical procedure 1. Incision: The median side incision on the left side. 2. Exploring the abdominal cavity: Checking for the presence or absence of metastases in the lesion, determining the extent of resection of the operation, and estimating the difficulties that may be encountered during the operation. For patients with cancer, the resection range should be at least 6cm from the cancer, 3cm to 5cm down, and at least 2.5cm above the levator ani muscle. 3. Separation of the sigmoid mesenteric root: The gauze band is used to tighten the intestinal lumen at both ends of the tumor, and the mesenteric artery and vein are sutured at the root of the mesentery. The posterior peritoneum on both sides of the sigmoid mesenteric root was dissected, and the spleen was straightened up to the rectal bladder recess (female to the rectal uterus), and the retroperitoneal fat and lymph nodes were isolated. 4. Isolation and ligation of mesenteric vessels: The mesenteric artery and vein roots are separated according to the range of preparation for resection, the nearby lymph nodes are swept, and the blood vessels are ligated. 5. Separation of the anterior and posterior rectum: According to the resection range, the anterior and posterior rectal space were separated, and the anterior rectum and the posterior wall of the bladder (female uterus) were separated, and the posterior side was separated from the humerus. 6. Severing the sigmoid mesenteric membrane: The sigmoid mesenteric membrane is cut from the upper end portion of the intestine segment to the inferior mesenteric artery ligation, and the blood vessel branch in the mesangium is ligated. 7. Resection of the diseased intestine segment: Cut the upper segment of the sigmoid between the two hemostats, and then cut the upper segment of the rectum between the two right-angled forceps (or bronchial forceps) to remove the diseased intestine. 8. Sigmoid colon rectal end-to-end anastomosis: end-to-end anastomosis between the sigmoid colon and the rectal end. The wall muscle layer is first sutured with silk suture (the rectum is only the muscle layer). After the jaw portion was removed, the posterior wall was sutured with a 2-0 gut suture, and the knot was struck in the intestine. The entire anterior wall was sutured by intestine varus. Finally, the anterior wall muscle layer was sutured with silk. 9. Set the flow strip: a cigarette is placed on the side of the anastomosis, and is drawn through the lower end of the abdominal incision. 10. Peritoneum after suturing: suture the peritoneum, so that the anastomosis is located outside the peritoneum, and both sides of the sigmoid colon and the posterior peritoneum are fixed. 11. Stitching the abdominal wall: layering the abdominal wall.

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