What Is an Antrectomy?

Artificial anal surgery or colostomy is a common surgical method. It refers to the need for treatment. The surgeon first makes an opening in the abdominal wall of the patient, then pulls a section of the intestine out of the abdominal cavity and fixes the opening of the intestine to the abdominal wall. It is used to excrete feces, which can be collected in a special plastic bag attached to the opening.

Artificial anal surgery

Artificial anal surgery or colostomy is a common surgical method. It refers to the need for treatment. The surgeon first makes an opening in the abdominal wall of the patient, then pulls a section of the intestine out of the abdominal cavity and fixes the opening of the intestine to the abdominal wall. For excretion

Clinically, we can see that due to the improper positioning of the stoma, it will not only increase the difficulty of postoperative stoma care or even make it impossible to perform satisfactory stoma care, but also bring additional pain and annoyance to the patient. Therefore, the correct and reasonable positioning of the artificial anus before surgery is of great significance for improving the quality of life of patients after surgery and for ostomy care. Pre-operative doctors, nurses or stoma therapists, family members and patients choose the stoma site. Specific requirements are as follows:

1) Regardless of the position, the patient can see the whole view of the stoma, which is convenient for nursing;

2) There should be enough flat skin area around the stoma to facilitate the sticking of the stoma floor and prolong the life of the floor;

3) The patient does not feel any special discomfort when the stoma floor is attached to the stoma skin.

When positioning, care should be taken to avoid the following areas: females should avoid sagging breasts; areas where surgical incisions may be made; costal margins; skin folds; outside the rectus abdominis; waist belts; iliac crests; scars Navel; site with hernia; site with chronic skin disease; pubic symphysis.

In addition, the patient should first be positioned in accordance with the above principles when lying down, then the patient should be positioned while sitting, and finally the patient should be positioned while standing. Only the stoma position can be achieved under the different body conditions described above. Satisfaction of the stoma positioning principle is satisfied at this time.

1) Stoma bleeding: It usually occurs in the first 72 hours after surgery. Most of the bleeding is in the capillaries and small veins at the junction of the intestinal stoma mucosa and the skin. It can be stopped by slightly pressing with a cotton ball or gauze: if the bleeding is more frequent It can be compressed with gauze soaked in 1 adrenaline solution or applied externally with Yunnan Baiyao powder: more bleeding may be caused by the mesenteric arterioles being unligated or the ligature falling off. At this time, 1-2 needle mucosal-skin sutures should be disassembled. Line, find the bleeding point and clamp it to stop bleeding completely. If the mucous membrane is damaged (can be caused by friction of the stoma device, the gauze should be applied with tetracycline ointment and then protected with vaseline gauze after hemostasis;

2) Ischemic necrosis of the intestine: This is a serious early complication, which usually occurs 24-48 hours after surgery. Mainly due to damage to the marginal arteries of the colon, excessive tension in pulling the bowel, twisting blood, and compression of the mesenteric blood vessels resulting in insufficient blood supply, or because the stoma is too small or the suture is too tight, affecting the intestinal wall blood supply. Necrosis is caused by ischemia, so it is very important to observe the blood flow of the stoma every day, especially the first two days after the operation. Ischemic necrosis can be divided into three degrees: in mild cases, the edge of the stoma mucosa is dark red or slightly black, but the range is not more than one third of the outside of the stoma, there is no increase in secretions and abnormal odor, and there is no change in the stoma skin. At this time, the iodine spinning cloth surrounding the stoma should be removed, all the items that oppress the stoma should be removed, and the furancillin solution or physiological saline should be used for external cleaning, and the biospectrometer should be irradiated twice a day for 30min each time. Or continually wet the new solution. 2/3 of the stoma mucosa is purple-black, with secretions and abnormal odor, but the mucous membrane in the stoma is still red or red, and mucosal bleeding can be seen by rubbing hard. The treatment is the same as before, after the clear tissue line between the normal part and the necrotic part appears, we can proceed to eliminate the necrotic tissue. The gap caused by the necrotic tissue can be properly filled with powder or cream skin care agent, and the second stage of wound can be promoted Heal. In severe cases, the stoma mucosa is all painted black, there are a lot of abnormal odorous secretions, and no bleeding point is seen in the friction mucosa. At this time, the stoma is severely ischemic and necrosis. It is advisable to perform emergency surgery, remove the necrotic intestine, and repeat the intestine. Stoma;

3) Intestinal stoma infection: This is one of the most common comorbidities. It is often a skin incision infection. It can occur subcutaneously or in the deeper abdominal wall. It begins to flush, swell and sore, and subsequently forms abscesses. The pus is drained and scars are formed after healing, which leads to a narrow stoma. Also evolved from abscess to fistula, long-term unhealed. When early infection is found, clean and wet compresses should be used to strengthen anti-inflammatory treatment. If abscesses are formed, drainage and drainage should be performed at an early stage to eliminate sutures. If a fistula has been formed, it is often necessary to remove the fistula or repeat the intestinal stoma.

4) Intestinal ostomy edema: Stoma mucosal edema can be seen 2-5 days after intestinal ostomy. Generally it does not need to be treated, and it slowly disappears after 1 week. If the stoma mucosal edema is aggravated and is grayish white, the stoma should be checked for sufficient blood flow, and continuous wet compress with normal saline or furacicillin solution, and if necessary, external irradiation with a spectrum analyzer;

5) Intestinal stoma stenosis: One week after the intestinal stoma, use your fingers (wearing gloves or finger cuffs) to expand the anus. Once a day, you can insert the second section of the index finger. The intestinal stoma is mainly the abdominal wall. The hole is too small or part of the fascia is not removed, or a scar ring is formed after infection. Mild stenosis can be used to expand the anus twice a day until it can be inserted into the second quarter of the index finger. Severe stenosis requires incision or removal of scar tissue around the stoma, and resuture the intestinal wall and the edge of the skin;

6) Retraction or introversion of intestinal stoma: Because the retraction or introversion makes the weight lower than the skin manifestation, causing lateral flow of feces and contaminating the surgical incision, severe retraction causes the intestinal segment to retract into the abdominal cavity causing peritonitis and contaminating the surgical incision. Severe retraction causes peritonitis. Mild patients can use a convex bottom plate, and fill the depression with a gel or sheet-shaped skin protector, and then install an artificial anal bag and wear a special belt. The severe person can only make an intestine stoma;

7) Intestinal stoma bulge or prolapse: Double cavity stoma bulge is horn-shaped; single cavity stoma intestinal prolapse can be up to tens of centimeters, which brings great inconvenience to the patient, and sometimes even an anal bag is difficult install. The lighter person uses an elastic abdominal band to slightly pressurize the intestinal stoma to prevent bulging or prolapse. The severe person needs to remove the bulging or prolapsed intestinal section. In many cases, the intestinal stoma must be redone.

8) Intestinal stoma internal and external hernia formation: this complication can only be performed again. If the intestinal obstruction is caused by internal hernia, it should be found in time for early surgery;

9) Inflammation of the skin around the colostomy: it may be fecal dermatitis caused by feces, or it may be allergic dermatitis caused by allergies (most commonly allergies to rubber bands, floor plates or stickers). Appears as flushing, congestive edema, skin erosion, or even the formation of ulcers, local severe pain. At this time, use normal saline or furacicillin solution to clean the wound, apply powdery or gel-like skin protection agent, and use a gel-like skin protection agent to flatten the sunken skin and folds, and then attach the sycamore tape which is easy to peel off. The plastic artificial anal bag is changed 1-2 times a day. In addition, supportive therapies need to be strengthened to increase the body's resistance and appropriate anti-allergic treatment.

With the improvement of medical standards, the survival time of patients after artificial anal surgery is very long. Therefore, how to take good care of the artificial anus so that patients can re-adapt to study, work and life, naturally become the concern of patients and their relatives and friends. Although the artificial anus cannot control venting and defecation as easily as a normal anus, as long as proper dieting, skin care and bowel cleansing training are available, patients can resume normal study, work and life.

1) Pay attention to diet hygiene and deployment: Pay attention to diet hygiene to prevent the occurrence of acute gastroenteritis. Due to the surgical removal of part of the intestine, the fecal transport pipeline becomes shorter after surgery, and it takes time for the body to re-establish defecation rhythm after surgery. Therefore, we must insist on three meals a day, avoid overeating, and eat more food with high nutrition and less residue. Eat or avoid irritating and flatulent foods such as onions, garlic, and yam, so as to avoid obstruction of the intestine and stoma and frequent use of intestinal ostomy pockets to cause inconvenience in life and work. By adjusting the diet, you can make stools;

2) Protect the skin: The skin around the colostomy will be stimulated by feces and intestinal fluid to produce dermatitis and even ulcers. Some patients are allergic to the stoma floor, which can also cause dermatitis and affect the quality of life of patients. Therefore, care must be taken to protect the skin around the stoma. The main principle is to keep the skin dry. In addition, you can also use some gardenia powder. If erosion has occurred, you can use zinc oxide ointment to coat the skin around the stoma. If allergies occur, you can apply some anti-allergic ointments, such as cleansing cream, etc. at the same time, it is recommended to use another brand of intestinal ostomy bag;

3) Develop regular bowel movements: Early bowel movements after artificial anus are often random, which not only causes inconvenience to nursing, but also affects normal life. The method of colonic lavage can be adopted, and the enema can be performed regularly, so that repeated stimuli can be used to form a regular bowel habit. This method is relatively simple. Patients can do it at home. It is generally recommended to enema at about 20:00 in the evening. This will not affect the study and work during the day, and it will not affect the meals and rest at night.

The construction of artificial anus is an important clinical treatment method for surgical treatment of rectal cancer and colorectal cancer. The construction of artificial anus has played an irreplaceable role in improving the quality of life and prolonging the survival of patients. However, patients are often afraid of making a colostomy in the abdomen and therefore refuse surgery. In order to overcome the shortcomings of quality of life and psychological state caused by colostomy, we have formulated pre- and post-operative rehabilitation management methods in clinical work, and the results are very satisfactory. Now introduced as follows.

1. Management before surgery The surgeon talks to the patient about the necessity of constructing an artificial anus before the operation, and obtains the patient's consent. Paramedics have written a description of the anal problem. Temporary or permanent. The details of which part of the body is built have no effect on returning to society.

2. Management of an open artificial anus after surgery. Bring an artificial anal appliance after the operation. To prevent incision wound infection, the artificial anal appliance should be in close contact with the skin and not cause skin inflammation, and the state of the anal wound can be seen through the artificial anal appliance. Within 2 to 3 days after surgery, the bowel movement was weak due to preoperative bowel management. There is almost no excreta in the open anus at one time, even if there is very little excreta. You can see the water sample and discharge it later. At this time, the use of the aforementioned artificial anal appliance is appropriate. Can fully ingest food orally, stop using antibiotics, and water samples will turn into soft stools, usually about 1 week to 10 days after surgery. Use cheap disposable set at this time