In children with congenital anal atresia, there is an external anal sphincter in both high, medium and low anal atresia. There is no difference and it is well developed. This means that the less important one is well developed. The important internal anal sphincter is exactly the opposite, the higher it is.
In anal atresia, the internal anal sphincter is poorly developed or even absent.
Doctors are like clever women, but they are most afraid of making a meal without rice. This has been said many times in the article.
Among congenital diseases in children, it is a common problem to live without rice, because most of the deformities in children with such deformities are due to underdevelopment of organs. For example, the esophageal atresia we talked about last time has the worst classification and can only be removed.
Other organs in the body are used to replace the missing esophagus.
Faced with this kind of child, the doctor can only be stingy and search desperately in the child's body, trying to find the residual tissue of the internal anal sphincter. For example, if the end part of the rectum and cecum is thickened, it may be the internal anal sphincter tissue, which can be brought to the doctor.
use.
Pena surgery is exactly like this, using the well-developed external anal sphincter and the remaining part of the internal rectal sphincter to form a new anus. It is accurately called posterior sagittal anoplasty. The direction of the scalpel is the same as the direction of the sphincter, which can
Minimizing damage to the sphincter is the highlight of this surgery.
It can be seen from here that Pena surgery is a traditional laparoscopy and not a new technology. Family members definitely prefer laparoscopy, which is less harmful to the human body. We have talked about this issue in the general surgery department. This kind of low-median rectal and anal surgery
Laparoscopy is difficult to operate and has no advantages, so laparoscopy is more often used for high anal atresia.
The first step, as Teacher Wu asked, is to determine which position.
Since Teacher Wu went to notify the operating room, it is conceivable that it is basically impossible to have a low position. There is usually a fistula in the low position that can be used for defecation, so there is no need to rush to operate the knife. After all, if the operation of such a young child is not life-threatening, the operation itself is too risky.
.
Students cannot use the teacher's behavior to answer the teacher's questions, otherwise the teacher will look down upon them.
To accurately determine the location of anal atresia, the most economical solution is to use a plain abdominal radiograph. If the child's condition permits, it is more accurate to take an inverted abdominal
Hold the child's head or shoulders steady with one hand and place the child in an inverted position for the X-ray taking.
Today, this child only had a simple abdominal plain X-ray taken. Several students gathered around the plain X-ray on the light board to carefully identify it.
This time it was Classmate Pan's turn to answer this question: "This is the blind end of the inflated rectum, and this may be the pubococcygeal muscle. The two are close to each other and should be in the middle." After saying this, Classmate Pan
Let’s look at the other two students first: Do you agree with my opinion?
"This visual inspection is a bit difficult. Is it more than two centimeters?" Lin Hao helped classmate Pan look at it with his eyes, intending to turn his eyes into a measuring stick to measure the distance between the rectum and anus. The textbook said that generally speaking, it is less than two centimeters.
One centimeter is the low level, and anything above two centimeters is the mid-to-high level.
It is difficult to determine the mid-level and low-level positions by taking local X-rays of this area.
The difficulty is. Classmate Xie added: "It also depends on the child's weight and size."
Some seem to think that if it is less than two centimeters, it should be a low position. The child in question is less than a month old and is small. Relatively speaking, if it is less than two centimeters, it is actually a large distance and it should be a high position.
It is not surprising to have such inaccurate results.