Transabdominal perineal sacrococcygeal teratoma resection

Treating diseases: teratoma Indication The main tumor part of the teratoma is located in front of the iliac crest and protrudes into the pelvic type III or IV. When the position is high and can not be removed by the operation of the ankle surgery, a transabdominal perineal tibial teratoma resection is needed. Preoperative preparation 1. Comprehensive physical examination before surgery, including rectal examination, to determine the extent of tumor invasion. If necessary, B-ultrasound, barium enema examination, CT scan, and lateral X-ray film of the sacral area can be used to help determine the size of the tumor in the pelvic cavity and the relationship with the rectum in order to develop a surgical plan. 2. When secondary infections, antibiotics should be given. 3. When the tumor wall is thin, the tension is large, there is a risk of necrosis and rupture, emergency surgery should be done to prevent the bleeding from causing rupture. 4. Prepare the bowel routinely before surgery. 5. When a huge tumor is removed, due to large wounds and high blood seepage, adequate blood should be prepared. Giant teratoma generally prepares blood for 1000-2000ml. 6. A good venous access should be established before surgery, and a venous incision should be made if necessary. 7. Place the stomach tube and catheter before surgery. 8. If the tumor is huge, selective angiography can be performed before surgery. When the condition is met, embolization of the large blood vessel entering the tumor is performed first, and then surgery can be performed to reduce intraoperative bleeding. Surgical procedure 1. Incision: The abdomen is made into an arcuate incision. The incision of the perineal incision with the perineal teratoma resection. 2. After laparotomy, the pelvic peritoneum is opened, and the rectum is pulled to one side to protect the ureter. The tumor is isolated from the pelvic cavity and should be in close contact with the tumor during the separation process. 3. Continue to separate the tumor from the pelvic cavity, and if necessary, ligation of the iliac artery and vein to reduce bleeding. When separating tumors, the rectum, urethra, prostate, and bladder should be properly protected. After the tumor is fully freed, the remaining steps can be completed when the perineal surgery field is completed. The abdominal wall incision was sutured layer by layer and the wound was bandaged. Change the sick child to the prone position and remove the tumor according to the perineal surgery procedure. This can greatly reduce the amount of bleeding and reduce the spread of malignant tumors, not easy to damage the bladder, and at the same time can understand the pelvic lymph node metastasis. When a huge dumbbell-shaped teratoma is difficult to perform in one operation, it can be performed in two phases. In the first stage, the upper part of the tumor is separated by the abdomen, and the supply blood vessels of the tumor and the middle and the middle of the vein are ligated. After 2 to 3 days, the tumor is completely removed by the perineal sputum, which can reduce the shock or death caused by extensive dissection, excessive surgical trauma, and excessive oozing. complication 1. After the tumor is resected, there is residual blood in the dead space, which may be secondary infection. Sometimes the wound is contaminated with feces and is also the cause of the infection. In case of infection, drainage should be carried out as soon as possible. When the wound is changed, try to isolate the anus and the wound to prevent further contamination from affecting wound healing. 2. Postoperative incontinence and incontinence, extensive pelvic excision when multiple tumors were removed; in addition, the anal external sphincter and levator ani muscle were damaged when the tumor was removed. The intraoperative operation is close to the tumor stripping, and the levator ani muscle and the external sphincter can be properly sutured after the tumor is removed, which can reduce the above complications. 3. The wound has not healed for a long time, and there is continuous discharge of secretions. Most of the tumors are not cut or the tumor is recurred, and should be surgically removed again.

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