Colorectal resection and retrorectal anastomosis

The surgical separation range is small, the damage is light, and the anterior wall of the lower rectum affecting the bowel reflex is retained, so that normal bowel movement and urination function are available after operation. In addition, this surgical method is simple, the operation time is short, and it is safe. Treatment of diseases: congenital megacolon in children with congenital megacolon Indication X-ray examination of congenital megacolon confirmed the sigmoid colon and rectal segment. The newborn is over 6 months old and is generally in good condition. 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 as the colorectal resection of the anus. After revealing a large intestinal fistula, it is proposed to go outside the incision, examine the diseased colon, and determine the extent of removal of the intestinal fistula. Cut the posterior peritoneum on both sides of the rectum and the anterior rectal wall of the rectum to reflex, pay attention to protect the ureter on both sides of the retroperitoneal rectum. 2. Separation of the rectum: Separation of the posterior rectal space to the tip of the tailbone, without separation on both sides. When separating, be careful not to damage the movements, veins and branches of the sputum. If there is oozing, fill the saline gauze in the gap to stop the bleeding. Then the anterior rectal space is separated, and it is generally separated to the plane of the peritoneal reflex plane. The entire separation step is simpler than the colorectal resection of the anal anastomosis, and can be tolerated by the child, and the nerves distributed to the bladder and genitals can not be damaged. 3. Cut the upper part of the rectum: clip the two bronchial forceps slightly above the rectal peritoneal fold, cut the rectum between the two clamps, and wrap the proximal rectum with dry gauze to avoid contaminating the wound. 4. Sleeve the distal rectal stump: suture the distal rectal stump with the No. 1 silk thread, and the outer layer of the muscle layer is continuously or intermittently sutured. 5. Isolation of the mesentery: the peritoneum of the descending colon was cut open and separated into the spleen. The sigmoid mesentery is then separated, the sigmoid colonic blood vessels are cut and ligated, and the left colonic artery and its branches are preserved to ensure the blood supply of the proximal intestinal tract. The separated descending colon can be pulled down to 2 cm below the pubic symphysis. 6. Excision of the megacolon intestinal fistula: removal of the huge sigmoid colon fistula, double sutured distal. The cut end of the proximal colon was temporarily sutured with a purse-string suture or the suture was continuously sutured with a 4th thread. A white and black traction line on the side of the rupture end membrane and the opposite side of the mesial is used as a marker for identification to avoid twisting when pulled out. Note the key to the above steps: the rectum should be cut in a higher plane, which makes the distal suture convenient; however, the enlarged colon should be removed as much as possible. Deletion of ganglion cells can often involve the colon to a certain height. Mucosal ulcers on the thickened intestinal wall are often difficult to heal, and it is difficult to pull out the huge colon, and it is difficult to be satisfied in the perineal suture; therefore, the colon of most cases must be separated into the spleen, including cutting the left vein of the colon. When you pull out the colon, you won't be nervous. 7. Cut the posterior half of the white line of the anal canal, and pull the colon to the perineum. Use your fingers to expand the anal sphincter, make a traction line on both sides of the anus, open the skin on both sides of the anus, use the small hook to open the skin under the anus, and use a sharp-edged knife to make a half-ring incision on the white line behind the anal canal. . Then, the anal canal is separated from the external sphincter and separated back to the posterior rectal space. The proximal colon is placed in the puller, and the proximal colon is pulled out of the body by the white line incision on the posterior side of the puller. 8. Anastomosis of the colon, rectum: first remove the temporary suture of the proximal colon, and suture the skin around the posterior wall of the proximal colon and the posterior side of the anus. Then select two full-teeth long-curved hemostats with good elasticity and high curvature. The semi-circular clamp clamps the posterior wall of the rectum and the anterior wall of the colon. Then, the two hemostatic forceps are brought together and tied with a thick thread. 9. Drainage: A cigarette is placed in the anterior fossa, and a small incision is taken from the anus to lead out of the body. After 1 week, the colorectal wall necrosis between the two clamps, after the two hemostats fell off, the colon and the rectum can be connected. complication Urinary tract complications, abdominal distension, can be placed in the anal canal. If acute enteritis occurs after surgery, it can be treated with colon flushing.

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