premanual resection

Manual anterior resection for surgical treatment of rectal cancer. This operation not only retains the anal canal and levator ani muscle, but also preserves the feeling of the lower rectum and the bowel reflex (if the length of the retention section is above 4~5cm), so it is best to retain the defecation control function during rectal resection. Surgery, the patient gradually recovers the ability to control and vent. If the intestine segment is kept short (3 to 4 cm), the storage function has not been compensated within 3 to 6 months after surgery, and the defecation is more frequent. The ability to identify exhaust, defecation and control of liquid feces is also temporarily reduced. After the time (3 to 6 months) and the sphincter exercise, the gradual improvement can be made. Curing disease: Indication 1, as a radical resection surgery, for rectal cancer or sigmoid colon cancer more than 11cm from the anus. 2. As a palliative resection, it is suitable for rectal cancer with an anal margin of more than 8 cm. 3, large and broad-based benign tumors (such as dermal papilloma) or inflammatory stenosis, after anastomosis is estimated to be more than 3cm in the anal margin. Contraindications 1, with partial colon obstruction, may be considered to do the transverse colostomy or Hartmann surgery first, and then anastomosis after 2 weeks. 2, the middle and lower rectal cancer lesions have penetrated the intestinal wall and infiltrated the surrounding structures. 3, senior, infirm, with other serious diseases of the heart, lung, liver, kidney dysfunction, can not tolerate transabdominal surgery. Preoperative preparation 1, the patient should explain the reasons for the implementation of colostomy (artificial anus), if properly handled, can still adapt to normal life. It is best to introduce a colostomy patient who can live normally. Talking to him is more convincing. 2, try to improve the patient's general condition, such as correcting anemia, hemoglobin should be above 12g; serum protein is too low or weight loss is significant, should first do intravenous nutrition. 3, female patients should do a vaginal examination to understand whether there is cancer infiltration. Those who need to remove the posterior wall of the vagina should wash the vagina every day for 2 days before surgery. 4, low fixed tumor, or cancer located in the anterior wall of the rectum and urinary symptoms, should be cystoscopy and retrograde ureterography or intravenous pyelography to understand whether there is any invasion of the genitourinary system. 5, after anesthesia under strict aseptic technique to place the catheter, preferably with Foley balloon catheter, and then the scrotum and penis (with the catheter) with adhesive plaster on the inside of the right thigh, the catheter is connected to the surgery Under the bottle. 6, all patients before surgery should be estimated the position of supine, sitting, standing colostomy, and make a mark, it is best to inject a little disinfection ink to avoid improper positioning during surgery. Surgical procedure 1, abdominal incision, intra-abdominal exploration, separation of rectum and sigmoid colon, ligation of the inferior mesenteric vessels and other surgical procedures, and rectal, anal canal combined with abdominal perineal resection. However, sometimes in order to make the colon have sufficient length and fit with the rectum without tension, the peritoneal recoil of the descending colon should be cut open to the spleen, free to descend the colon, and if necessary, the sacral ligament and spleen colon ligament should be cut off. And part of the gastric collateral ligament, so that the spleen of the colon is fully free. 2, lift the upper rectum and sigmoid colon, in the rectum clip 5 cm below the distal end of the cancer, two right angle clamps, the two clamps are about 1cm apart, cut the rectum by the lower end of the intestine, the rectal end is wiped with 2% red mercury cotton ball . 3. Use two right angled intestines to clamp the proximal sigmoid colon to be cut and cut off the sigmoid colon. Excised bowel and diseased tissue were removed. 4, the proximal colon is sent down into the pelvic cavity, close to the rectum, ready for end-to-end anastomosis. First, the two sides of the rectal end and the end of the colon are sutured with two needles and no absorption line, and the traction is performed. The posterior wall muscle layer of the anastomosis was then sutured with a thin, non-absorbable line. A small intestine forceps was placed at the proximal end of the sigmoid colon to remove the portion of the sigmoid colon and rectum that was squeezed by the right angle clamp. 5. Fully continuous suture of the posterior wall of the anastomosis with a 2-0 chrome gut. 6. Use another 2-0 chrome gut to make a full-layer continuous inversion suture of the anterior wall of the anastomosis. 7. After suturing, cut off the traction lines on both sides, take out the intestinal clamp, and use the fine non-absorption line to make the suture between the anterior wall and the suture. 8. After rinsing the pelvis with warm saline, a double-casing cigarette is placed on the wall of the anastomosis to make a puncture at the perineum. Then, the pelvic floor peritoneum was repaired with a No. 1 chrome gut suture, and the pelvic floor was reconstructed so that the anastomosis was placed outside the peritoneal cavity. Finally, the abdominal wall incision was sutured layer by layer. After the operation is completed, apply the finger to expand the anus to 4 fingers. complication 1. Anastomotic rupture is the main postoperative complication. The cause of rupture is generally due to poor supply of blood in the anastomosis of the intestine, tension at the anastomosis, insufficient suturing technique, or poor preparation of the intestine. The anastomotic rupture mostly occurs in the posterior, generally no more than 1/3 of the circumference. If the treatment is improper, about half of the fecal fistula is formed; a few can lead to extraperitoneal pelvic abscess, and the abscess can be inserted into the rectum through the anastomosis or into the vagina. drainage. If there is difficulty in the anastomosis and it is not very reliable or there is more feces in the intestine, it is advisable to make a transverse colostomy in the right upper abdomen after the operation, and temporarily transfer the feces to prevent the anastomotic rupture. After the proximal colostomy, even if the anastomosis is broken and infected, it can self-heal. 4 to 6 weeks after the anastomosis is healed, local inflammation and edema subsided, and colostomy closure is feasible. 2, anastomotic stenosis is rare, if you can not make the intestinal wall over-inversion during anastomosis, and use intermittent suture, the stenosis will not occur. If the anastomosis has been ruptured for more than half a week and a transverse colostomy has been performed, anastomotic stenosis may occur. However, most of the stenosis can be naturally expanded by the formed feces. In cases where the anastomosis is almost ruptured throughout the week, the resulting stenosis must be dilated with a dilator to restore a suitable circumference. For those who have performed transverse colostomy at the same time, the early closure of the stoma should be sought to avoid the narrowing of the anastomosis due to excessive use of the dissection. If the transverse colostomy cannot be closed early, the distal colon enema and anal canal should be performed regularly at 2 weeks after surgery to prevent anastomotic stricture. Oral paraffin should not be taken orally 2 weeks after surgery to maintain stool formation and is one of the measures to prevent anastomotic stricture.

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