Want to take the child's life.
In children with congenital anal atresia, there are no differences in the external anal sphincter, which is well developed. In other words, the less important ones are well developed. The important internal anal sphincter is exactly the opposite. The higher the anal atresia, the worse the internal anal sphincter is developed, or even absent.
A doctor is like a skilled cook who is most afraid of not having enough rice to cook. This has been mentioned many times in the article.
In the field of congenital diseases in children, it is a common problem that there is no cure, because the deformity of these children is mostly due to the incomplete development of organs. For example, in the case of esophageal atresia, which is the worst type, other organs in the human body can only replace the missing esophagus.
When faced with such children, doctors can only be stingy and search hard in the children's bodies, trying to find residual tissue of the internal anal sphincter. For example, thickening at the end of the rectum and cecum may be internal anal sphincter tissue that can be used by doctors.
Pena surgery is exactly like this, using the well-developed external anal sphincter and the residual part of the internal rectal sphincter to form a new anus. Its correct name is posterior sagittal anoplasty. The direction of the scalpel is the same as the direction of the sphincter, which can minimize the damage to the sphincter, which is the highlight of this operation.
From this we can see that the Pena procedure is a traditional laparoscopic procedure, not a new technology. Family members would definitely prefer laparoscopy, which is less harmful to the human body. We have talked about this issue in general surgery. This type of low-mid rectal anus surgery is difficult to operate with laparoscopy and has no advantages, so laparoscopy is more often used in high-position anal atresia.
The first step is, as Teacher Wu asked, to determine what position.
Considering that Teacher Wu went to notify the operating room, it is conceivable that it is basically impossible to be low-lying. Low-lying ones usually have fistulas to defecate, so there is no need to rush to operate. After all, if such a young child is not in danger of life, the operation itself is too risky.
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Students are not allowed to answer the teacher’s questions by using the teacher’s behavior, or the teacher will roll his eyes at them.
To accurately determine the location of anal atresia, the most economical solution is to use a plain abdominal X-ray. If the child's condition allows, taking an inverted abdominal X-ray can be more accurate, that is, the accompanying person grabs the child's feet and holds the child's head or shoulders with the other hand to make the child stand upside down to take the film.
Today, this child only had a simple abdominal X-ray, and several classmates gathered around the light board to carefully examine the film.
This time it was Pan's turn to answer the question: "This is the inflated blind end of the rectum, and this side may be the pubococcygeus syndesmosis muscle. The two are relatively close and should be in the median position." After saying this, Pan looked at the other two students first: Do you agree with my opinion?
"This is a bit difficult to estimate visually. Is it more than two centimeters?" Lin Hao helped Pan to look with his eyes, intending to use his eyes as a ruler to measure the distance between the rectum and the anus. The textbook said that generally speaking, less than two centimeters is low, and more than two centimeters is medium-high.
It is difficult to judge the middle, high and low positions when taking local X-rays of this area.
The difficulty lies. Xie added: "It also depends on the child's weight and size."
For some, it seems that less than two centimeters should be a low position. The problem is that the baby is premature and small. Relatively speaking, this distance less than two centimeters is actually a large distance and is a high position.
It is not surprising that the results are not very accurate.
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