What Is an Antrostomy?

This operation is one of the more commonly used procedures to treat the congenital megacolon. It preserves the lower rectum and can have normal defecation reflexes after surgery to avoid intra-abdominal infection. The disadvantage is that the tissue damage is large, the pelvic plexus is easily destroyed, causing postoperative bladder paralysis, and prone to anastomotic leakage and stenosis, and the mortality is high.

Colorectal external anal anastomosis

This operation is one of the more commonly used procedures to treat the congenital megacolon. It preserves the lower rectum and can have normal defecation reflexes after surgery to avoid intra-abdominal infection. The disadvantage is that the tissue damage is large, the pelvic plexus is easily destroyed, causing postoperative bladder paralysis, and prone to anastomotic leakage and stenosis, and the mortality is high.

Chinese name

Colorectal external anal anastomosis colorectal external anal anastomosis

Foreign name

Swenson

Missing point

Tissue damage

Indication

X-ray examination of congenital megacolon

Solid

One of the operations for congenital megacolon

X-ray examination of congenital megacolon confirmed that the sigmoid colon and rectal segment were narrow. Newborns who are over 6 months old and generally in good condition.

1. Admitted to the hospital 4 weeks before surgery, with less slag diet, 60ml of oral liquid paraffin, enemas 1 or 2 times a day.

2. Oral succinyl sulfathiazole and other drugs were started 2 weeks before the operation. If combined with colitis, repeated diarrhea can be repeated with normal saline, three times a day, and oral neomycin 50mg 100mg / kg · d, orally divided into 3 to 4 times.

3. After proper colon preparation, if the fecal condition still does not improve, you should consider transcolostomy first. Radical resection of the sigmoid colorectum is usually performed 3 to 6 weeks after the fistula.

4. Intravenous infusion to correct the imbalance of water and electrolyte balance; small or multiple blood transfusions to improve malnutrition and anemia, and strengthen surgical tolerance.

5. Make a detailed inspection of the urinary system; pay attention to whether the sick child is complicated by diseases such as upper respiratory tract infection and pneumonia, and treat them in a timely manner if necessary.

6. An anal canal can be inserted 48 hours before surgery, and enema 3 times a day. Enema must use normal saline, avoid water, because a lot of water is quickly absorbed from the wide intestinal mucosa into the circulatory system, water poisoning will occur, leading to heart failure and death. Even when using saline enemas, each kilogram of body weight should not exceed 100ml. After the above preoperative preparations, there should be no fecal accumulation in the colon, and the abdomen is boat-shaped, and surgery can be performed.

7. Lower gastric tube on the day of surgery.

8. Prepare blood and match with 400ml.

9. When possible, prepare for frozen section inspection.

General anesthesia

2. Thiopental sodium anesthesia plus sacral anesthesia.

1.Position the child on the large plate, with the hips raised, and the perineum placed on the edge of the large plate to facilitate the surgical operation of the perineum. The two upper limbs and the left lower limb are fixed on the large plate, and the left ankle vein is incised. , The right lower extremity is not fixed to facilitate the perineal movement. Place the indwelling catheter.

2. The incision is inferior to the left and middle and incisions, from 1cm above the umbilicus to the upper edge of the pubic bone, and is 6-7cm long.

3. After intraperitoneal exploration, the sigmoid colon was raised out of the incision and examined. The dilated sigmoid colon became a narrow rectal segment, which was a ganglion-free intestinal cramp. The intestinal ducts above the spastic section are secondary enlarged, the intestinal wall is hypertrophic, pale, tarnished, the colon is sparse, and the intestinal tube loses its peristaltic function. It usually returns to the upper part of the descending colon. The above abnormal bowel loops should be completely removed.

4. Separate the rectum and the sigmoid mesentery and cut the sigmoid and the sides of the rectum and the peritoneum of the rectum and bladder fossa, taking care not to damage the ureters on both sides. In order to fully move the sigmoid colon, the sigmoid artery branch needs to be cut off, and the ligature and cut should be near the starting point of the artery, so that the vascular arch can be preserved and the intestinal wall can have sufficient blood flow. The main trunk and branches of the left colonic artery were retained to ensure blood flow to the proximal colon. To remove most of the descending colon, sometimes the left artery of the colon is severed. Separated in the upper rectum, reaching the level of the levator ani muscle at the bottom of the pelvis. In order to avoid damage to the bladder nerve, the rectum should be separated as close to the intestinal wall as possible. The upper and middle hemorrhoids encountered during the anatomy need to be ligated and cut off.

5. Resection the sigmoid colon and rectum, and temporarily close the stump to remove the huge sigmoid colon and rectal stenosis. When conditions permit, frozen sigmoid colon wall tissue should be taken for frozen section examination; if abnormal, another section should be removed. First close the stump of the proximal colon, and use a white line on its mesangial side, and a black line on the opposite side of the mesentery (or one with thick and thin on the other side) as a mark to prevent the intestine from being pulled out. To reverse. Then use a silk suture to close the stump of the rectum in succession, and then add a discontinuous suture.

6. Pull out the rectum and stump of the colon. Use long hemostatic forceps or oval forceps to insert 0.1% neogel or thimerosal liquid gauze ball into the anus. After disinfecting the rectum, apply the left hand to the rectum against the rectum The stump, and clamp the inner wall of the rectum stump with oval forceps, pull out to the anus, turn the rectum stump out, and become a tube sleeve with the mucosal layer outward. At approximately 3 cm above the tooth line, cut the anterior wall of the rectum stump transversely. Then, insert long-curved hemostatic forceps into the pelvic cavity from this incision, clamp the traction line of the proximal colon stump, and pull out the proximal colon about 4cm outside the anus, taking care not to twist the intestine.

7. Anastomosis the rectum and colon firstly suture the anterior rectum wall muscle layer and the anterior wall of the colon, and then cut out the extra rectum outside the anus, and suture the posterior wall muscle layer and the posterior wall of the colon. . Then, the anterior wall of the proximal colon is cut open, the contents of the colon are exhausted, and the rectum and the anterior wall of the colon are sutured intermittently at all levels. Finally, the posterior wall of the colon is cut open, and the entire rectum and posterior wall of the colon are sutured while cutting, until the excess colon is completely removed, and the anastomosis of the colon and rectum outside the anus is completed. Return the anastomosis to the anus, place a cigarette on the back of the anastomosis, and drain it through a small incision on the back of the anus.

After the peritoneal incision is closed, the abdominal wall incision is closed layer by layer.

1. The intestinal wall biopsy should be taken as a frozen section at the time of the operation to find out whether the ganglion-free intestinal loop and the secondary large non-functioning bowel loop have been completely removed to reduce postoperative recurrence. If there is no frozen section inspection equipment, the following points can be used as a reference during surgery:

The length of the giant colon resection should be at least 25cm.

The swollen colon must be completely removed.

(3) The intestinal wall is thick and pale, the colon is sparse, the intestines are loose, and the elasticity and peristaltic function are lost. They are all signs of abnormal intestines and must be removed.

2. In the anal anastomosis of the colon and rectum stump, the bowel has a tendency to retract into the anus, making the anastomosis difficult, and it must be cut and stitched; especially, the back wall should be sutured firmly to avoid anastomosis Leak in mouth.

3. When performing perineal operation, the first assistant can simultaneously suture the pelvic peritoneum and suture the abdominal wall layer by layer. If the upper and lower groups are performed at the same time, the operation time can be greatly shortened, and the infants have more opportunities for recovery.

1. Postoperative fasting and fluid replacement are required. If the abdomen does not swell and the bowel sounds recover, you can start eating after defecation.

2. Attention should be paid to urinary tract complications. The urinary catheter should be left after the operation, and any urination will flow out within 3 to 4 days. Those who cannot urinate automatically after extubation should continue to be indwelling and flushed until the catheter is removed ten days after surgery.

3. If there is abdominal distension, anal canal can be placed to ventilate. If acute enteritis occurs after surgery, colonic irrigation can be used for treatment.

4. Cigarette drainage in the posterior rectal space was removed 2 to 3 days after surgery.

5. In order to prevent anastomotic contraction and stenosis, digital anal canal diagnosis should be performed regularly within 2 to 3 months after operation, and appropriate expansion should be performed. ^[1]