radical proctectomy

Radical rectal resection is the main treatment for radical treatment of severe rectal diseases such as rectal cancer. Treatment of diseases: rectal cancer Indication 1. Low rectal cancer, such as resection to 2~3cm below the tumor, the normal intestine segment of the anorectal ring is incomplete. 2. Rectal cancer invasion and rectal ring. 3. Intestinal invasion of rectal cancer in the middle and lower stages is more extensive. 4. Male, obese, pelvic and narrow, etc. due to anatomical conditions can not be used for rectal tumor resection and anastomosis. 5. Anal canal and anal around the aneurysm. Contraindications 1. Old age, infirmity, poor general condition, severe heart, lung, liver, kidney and other organ dysfunction, can not tolerate abdominal surgery. 2. The local pelvic cavity of rectal cancer has extensive infiltration or frozen pelvis. Preoperative preparation Preoperatively combined with radiation therapy and chemotherapy, can improve the efficacy. Surgical procedure 1. Position: The patient has a low head, a femoral extension, an abduction, and a bladder lithotomy position. The hips are raised 15°~30°, so that the pelvic and abdominal organs leave the pelvis to facilitate the visualization of the surgical field, but it should not be excessively elevated to prevent the diaphragm from being compressed by the abdominal organs and affecting the breathing. 2. Incision: According to the patient's position and fat and thin, you can choose to make a left inferior ventral midline incision or a mid-umbilical midline incision, and if necessary, extend to the umbilicus. 3. Exploration: After the abdomen, the liver, stomach, gallbladder, and spleen should be explored in turn. The whole colon is from the ileocecal, ascending colon, hepatic curvature, transverse colon, spleen, descending colon, sigmoid colon. The pelvis includes the female uterus and bilateral attachments. Finally, the rectum is rubbed, and along the sigmoid mesenteric, the lymph nodes around the base of the intestine and the inferior mesenteric vessels are pressed up. 4. The mesenteric vascular roots were exposed to remove the perivascular lymphoid tissue, and the left mesenteric artery was ligated and sutured to the inferior mesenteric vessels. 5. The assistant lifts the rectum and sigmoid colon, reveals the ureter, cuts the peritoneum along the sides of the sigmoid mesenteric root on the inside, enters the retroperitoneal space behind the mesentery, and cuts the peritoneum down the sides of the rectum to the rectum. The condylar peritoneal reflex fold meets about 1cm, pay attention to protect the inferior epigastric nerve, enter the anterior tibiofibular space on the iliac crest, and sharply separate between the pelvic fascia (the deep rectal fascia) and the parietal fascia under direct vision. Before the anterior sacral space, the rectum is pulled forward as far as possible with a deep S-shaped hook to protect the rectum and the pelvic fascia intact. The tibia rectal fascia is cut down, and the separation behind the rectum should go beyond the tip of the tailbone to the pelvic floor levator ani muscle plane. 6. Separate sharply along both sides of the rectum, cut off the bilateral ligaments on both sides, pay attention to the blood vessels in the rectum on both sides, and if there is bleeding when disconnected, it can be ligated. Because the blood vessels in the rectum can be absent in some cases, it is not necessary to routinely clamp the rectal ligament without conventional blind clamp ligation. When the lateral ligament is broken, care should be taken to protect the parasympathetic nerves on both sides of the pelvic wall. The lateral rectal dissociation also needs to reach the pelvic floor levator ani muscle plane. 7. The front of the rectum is cut along the peritoneum and cut into the Denonvillier fascia and the deep rectal fascia. The male is exposed to the spermatic cord. The spermatic cord is retracted forward on the dorsal side of the spermatic cord and separated down along the deep rectal fascia. Under the prostate plane. In women, the posterior wall of the vagina should be pulled forward and separated between the vagina and the rectum. Be careful not to stick too close to the vaginal wall to avoid injury and vaginal venous plexus. 8. The left colonic vascular arch was left ligated and disconnected from each branch of the sigmoid colon. The lower 1/3 of the sigmoid colon was dissected by blocking the intestinal lumen with two deMartel forceps or non-injured intestinal clamp. The excised specimen can be removed from the perineal incision. After the specimen is removed, the pelvic cavity is rinsed with a disinfecting solution, and after the blood is tightly stopped, the peritoneum of the pelvis is closed. The negative pressure drainage tube is placed in the pelvic cavity to the left iliac crest or pulled out from the lower end of the incision, and can also be drawn out through the inside of the perineal ischial tuberosity. 9. The proximal sigmoid colon can be made through a small incision in the upper left 1/3 of the left lower abdomen, and the circular skin with a diameter of 2.0 cm is removed. Then the sigmoid colon is extracted through the incision of the rectus abdominis muscle fibers, and the peritoneum and the intestinal wall are fixed by four needles. In the abdominal incision, suture by layer, remove deMartel forceps or non-injured right angle intestinal clamp, and suture the colon end and the skin in full thickness. The sigmoid colon can also be drawn through the upper end of the incision and the umbilicus 2 transverse plane to perform the end ostomy.

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