STARR手术治疗排便梗阻综合征ODSPPT学习教案

1、会计学1STARR手术治疗排便梗阻综合征手术治疗排便梗阻综合征ODS第1页/共33页第2页/共33页第3页/共33页第4页/共33页demonstrate the characteristicanatomical abnormalities demonstrated ondynamic defecography and MRI in patients withODS.（a）as the patient begins to strain an anterior rectocele begins to appear(b) the vagina assumes a horizontal positi

2、on, the rectocele enlarges, and a small intussusception becomes apparent第5页/共33页show the intraoperativeappearances of a rectocele and anorectal prolapse.( c ) the internal rectal prolapse increases and descends toward the anal canal( d ) the internal rectal prolapse plugs the anal canal, the rectoce

3、le fails to empty, and complete obstruction to defecation results第6页/共33页Dynamic MRI images illustrating the characteristic anatomical abnormalities associated with ODS. ( a ) formationof a large anterior rectocele, ( b ) the vagina assumes a horizontal position, and the rectum evaginates as a recto

4、celeand invaginates as an internal rectal prolapse, ( c ) an enterocele descends to fill a low-lying Pouch of Douglas,obstructing defecation. b bladder, r rectum, i internal rectal prolapse (intussusception),第7页/共33页X-ray defecography showing an isolated pulsionrectocele (r) during straining; small

5、bowel (S), bladder (B), vagina (V)第8页/共33页X-ray defecography showing an enterocele filledwith small bowel loops (Sb) filling the rectovaginalspace during straining; rectum (R) and rectocele (re),vagina (V), bladder (B)第9页/共33页Intraoperative appearance of a rectocele. Theexamining finger in the rectu

6、m bulges forward into thelower vagina第10页/共33页Intraoperative demonstration of internal rectalprolapse. The circular anal dilator of the PPH01 set isplaced in the anal canal. A dry swab on a sponge holderis inserted and slowly withdrawn, bringing with it theprolapsing distal rectum第11页/共33页Internal r

7、ectal prolapse as observed througha flexible sigmoidoscope. A previous stapled hemorrhoidopexyline can be seen ( arrowhead ), which hasfailed to treat the symptomatic prolapse第12页/共33页第13页/共33页第14页/共33页第15页/共33页第16页/共33页第17页/共33页第18页/共33页第19页/共33页第20页/共33页第21页/共33页第22页/共33页第23页/共33页第24页/共33页术前晚及术晨各清洁灌肠，阴道清洁。两把PPH吻合器，金属压舌板一个腰麻或硬外麻，麻醉后取截石位，用肛管扩肛器置入肛门扩肛，取出内芯，将肛管扩肛器缝扎固定。第25页/共33页第26页/共33页于直肠前壁由于直肠前壁由9 9点到点到3 3点作点作3 3个半荷包，深及肌肉层，各相距约个半荷包，深及肌肉层，各相距约1cm1cm。用压舌板挡住直肠后壁，。用压舌板挡住直肠后壁，置入吻合器，将三根荷包线绕吻合器连杆置入吻合器，将三根荷包线绕吻合器连杆同时收紧打结，自侧孔引出，轻轻拉紧，同时收紧打结，自侧孔引出，轻轻拉紧，旋紧吻合器，检查阴道壁，以防损伤。关旋紧吻合器，检查阴道壁，以