Want to take the life of the child.
In children with congenital anal atresia, there is an external anal sphincter in both high, middle and low anal atresia. There is no difference, and the development is good. It is equivalent to saying that it is not very important to develop but it is good. The important internal anal sphincter is just the opposite. The higher the anal atresia is, the less developed or even absent the internal anal sphincter is.
A doctor is a clever woman who is most afraid of cooking without rice, which has been said many times in the article.
Among children's congenital diseases, cooking without rice is a common problem, because most of the deformities in children with such deformities are due to organ hypoplasia. Just like the esophageal atresia we talked about last time, the worst type can only be found in other organs of the human body to replace the missing esophagus.
Faced with this kind of child, the doctor can only stingily search the child's body desperately, intending to find the residual tissue of the internal anal sphincter. For example, the thickening of the end part of the rectum and cecum may be the tissue of the internal anal sphincter, which can be brought to the doctor. use.
Pena surgery is just like this, using the well-developed external anal sphincter and the remnant part of the internal rectal sphincter to form a new anus. Its accurate name is posterior sagittal anoplasty. The direction of the scalpel is the same as that of the sphincter, which can avoid damage to the sphincter to the greatest extent, which is the highlight of this operation.
It can be seen from this that Pena surgery is a traditional non-new technology laparoscopy. The family members definitely prefer laparoscopy with less harm to the human body. We have talked about this issue in the General Surgery Department. There is no advantage that laparoscopy is difficult to operate on the low-middle rectum and anus surgery, so laparoscopy is more often used in high-position anal atresia.
The first step, as Mr. Wu asked, is to determine what position.
In view of Mr. Wu's notification to the operating room, it is conceivable that it is basically impossible to be low. Generally, there is a fistula in the lower position to defecate, and there is no need to rush the knife. After all, if such a young child is not in danger of life, the surgery itself is too risky.
Students can't use the teacher's behavior to answer the teacher's questions, and they will get the teacher's eyes.
To accurately determine the location of anal atresia, the most economical solution is through abdominal plain film. If the child's condition permits, it is more accurate to take an inverted abdominal X-ray film, that is, the escort grabs the child's feet and the other hand holds the child's head or shoulders to stabilize the child's head or shoulders so that the child can take the film in an upside-down position.
Today, the patient just took a simple abdominal plain film, and several students carefully judged the plain film around the light board.
This time it is Pan's turn to answer this question: "This is the inflated blind end of the rectum, and this side may be the pubic and coccygeal muscles. The two are relatively close, so they should belong to the median." First look at the other two students: Do you agree with me
"It's a bit difficult to measure visually. Is it more than two centimeters?" Lin Hao helped Pan with his eyes, intending to use his eyes as a measuring stick to measure the distance between the rectum and anus. As mentioned in the textbook, generally speaking, less than two centimeters is low, and more than two centimeters is middle-high.
It is more difficult to judge the middle, high and low positions in local radiographs of such parts.
Difficulty. Classmate Xie added: "It also depends on the child's weight and size."
Some seem to be lower than two centimeters, and the problem child is less than a month old and small in stature. Relatively speaking, the distance less than two centimeters is actually a high position.
It is not surprising to have such inaccurate results.