What Is a Rectocele?
Radical rectal resection is suitable for low rectal cancer, such as resection to the normal intestine segment 2 ~ 3cm below the anorectal ring has been incomplete.
Radical rectal resection
Right!- Radical rectal resection is suitable for low rectal cancer, such as resection to the normal intestine segment 2 ~ 3cm below the anorectal ring has been incomplete.
- What are the conditions for radical rectal resection?
1. Low rectal cancer, such as those who have been removed to the normal intestinal segment 2 ~ 3cm below the tumor.
2. Rectal cancer invasion and rectal ring.
3. Extensive intestinal invasion of lower and middle rectal cancer.
4. Male, obese, narrow pelvis, etc. cannot perform rectal tumor resection and anastomosis due to anatomical conditions.
5. Cancers around the anal canal and anal margin.
What are the contraindications to radical rectal resection?
1. Those who are old, frail, have poor general condition, with severe heart, lung, liver, kidney and other organ dysfunction, and cannot tolerate laparotomy.
2. There is extensive infiltration or frozen pelvis in the local pelvic cavity of rectal cancer.
Detailed surgical procedures of radical rectum resection 1. Posture: The patient takes a low head, femoral extension, abduction, and bladder lithotomy position. The elevation of the buttocks is 15 ° ~ 30 °, so that the pelvic and abdominal organs leave the pelvic cavity to facilitate the visualization of the surgical field, but it should not be excessively raised to prevent the diaphragm from being compressed by the abdominal organs and affecting breathing.
2. Incision: According to the patient's position and fatness, you can choose to make a left inferior abdominal midline incision or a subumbilical midline incision, which can be extended to the umbilicus if necessary.
3. Exploration: After entering the abdomen, the liver, stomach, gallbladder, and spleen should be explored in sequence. The entire colon is ileocele, ascending colon, hepatic curvature, transverse colon, spleen curvature, descending colon, and sigmoid colon. The pelvic cavity includes the female uterus and bilateral accessories. Finally, touch the rectum, and press the sigmoid colon upward to press the upper sacral rectum and sub mesenteric vessels around the roots of the enlarged lymph nodes.
4. Reveal the mesenteric blood vessel roots to clear the fatty lymphoid tissue around the blood vessels, and ligate and suture the left colonic artery from the plane of the initiation of the left mesenteric blood vessels.
5. The assistant lifts the rectum and sigmoid colon, reveals the ureter, cuts the posterior peritoneum along both sides of the mesentery root at the inner side, enters the retroperitoneal space behind the mesentery, and cuts the posterior peritoneum along the sides of the rectum to the front of the rectum. Meet at about 1 cm above the foldback of the depressed peritoneum, pay attention to protect the abdominal nerves, enter the presacral space on the promontory, and sharply separate the pelvic fascial organ (deep rectum) from the parietal fascia under direct vision. In the anterior space, use a deep S-shaped hook to pull the rectum forward as far as possible to protect the pelvic fascia intact after the rectum. Cut down the sacral rectal fascia, and the separation behind the rectum should extend beyond the tip of the coccyx to the level of the pelvic floor anus levator muscle.
6. Acute separation along both sides of the rectum, cut off the ligaments on both sides, pay attention to the blood vessels in the rectum on both sides, and ligate if there is bleeding during the dissection. Due to the lack of blood vessels in the rectum in some cases, conventional blind forceps are not required for severing the rectal ligament, and care must be taken to protect the parasympathetic nerves on both sides when severing the ligament. The lateral rectum must also reach the level of the pelvic floor anus levator muscle.
7. Make an incision in the front of the rectum along the peritoneal reentry into the Denonvillier fascia and deep rectal fascia. The spermatic cord is exposed in the male. The spermatic cord is pulled forward on the dorsal side of the spermatic cord and separated down to the deep rectal fascia. Prostate level. In women, the posterior wall of the vagina should be pulled forward, and the space between the vagina and rectum should be separated. Take care not to press the vaginal wall too tightly to prevent injury to the vaginal venous plexus and cause bleeding.
8. The left colonic vascular arch was ligated and separated from each branch of the sigmoid colon, and the intestinal cavity was cut off with two deMartel forceps or non-injury bowel forceps in the middle and lower 1/3 of the sigmoid branch. The resected specimen can be removed from the perineal incision. After the specimens were removed, the pelvic cavity was rinsed with a disinfecting solution. After the hemostasis was tightly closed, the pelvic peritoneum was closed. A negative pressure drainage tube is left in the pelvic cavity until it is protruded from the left condyle or from the lower end of the incision, or it can be extracted from the inside of the perineal ischial tuberosity.
9. The proximal sigmoid colon can be made through a small incision in the upper third of the left lower abdomen, and the circular skin with a diameter of 2.0 cm is excised. Then the sigmoid colon is extracted through the rectus abdominis muscle fiber incision, and the peritoneum and the intestine wall are fixed by four needles. , Suture the abdominal incision layer by layer, remove the DeMartel forceps or non-invasive right-angled bowel forceps, and make a full-layer discontinuous suture between the colon end and the skin. The sigmoid colon can also be pulled out through the horizontal plane of the inferior umbilical 2 horizontal fingers to perform an endostomy.
What do I need to prepare for radical rectal resection?
Preoperative supplementation with radiation therapy and chemotherapy can improve the efficacy.
How to care after radical rectal resection?
Note that nutrition should be added after surgery to avoid bleeding after the wound.
What should I pay attention to for radical rectal resection?
1. Before freeing the rectum, double-ligate with gauze or thick silk at the junction of the rectum and sigmoid colon to block the intestinal cavity, and inject 5-FU1000mg into the distal intestinal cavity to reduce the spread of cancer cells when the rectum is separated. The danger of planting.
2. When incision of the sigmoid colon, rectum and mesentery root, the intestine segment should be pulled up tightly, close to the inside of the root and the junction of the retroperitoneum, so that it is easy to avoid the ureter, and it is not necessary to routinely dissect and expose the ureter.
3. Enter the posterior rectal space at the level of the prosthesis. The gap should be sharply separated under the direct view of the gap. Pay attention to protect the abdominal nerves and lift the deep S-shaped hook forward and upward. Beyond the tip of the coccyx.
4. When performing lateral separation and detachment of the lateral ligament, it should be pulled outward with a deep S-shaped hook to protect the ureter.
5. When ligating and severing off the mesenteric blood vessels, care must be taken to avoid the left ureter behind it to avoid accidental injury.