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先天性巨结肠拖出术

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ID: ANH13118chis
医学动画文字记录:先天性巨结肠是一种婴儿出生缺陷,其一部分大肠无法正常排出废物。这会导致新生儿大肠阻塞。大肠包括结肠和直肠。消化后的食物通过小肠,进入大肠。当通过结肠时,水和盐被吸收,形成固体废物。废物进入直肠,然后通过肛门排出体外。在正常的怀孕过程中,神经细胞沿着发育中的神经系统到达生长中的消化系统,包括大肠。这些神经细胞发育成大肠肌肉层之间的神经节细胞。神经节细胞向肌肉层发送神经信号,使其收缩和舒张。这些收缩是一系列波状运动的一部分,波状运动推动废物通过整个大肠。在新生儿中,这种运动将废物沿着大肠推向直肠和肛门。如果胎儿患有巨结肠,则这些细胞或者没有到达这个区域,或者到达后没有发育为功能正常的神经节细胞。出生时,一部分大肠神经节细胞缺如,也可以累及一小段或一大段结肠,很少会累及整个结肠。如果没有神经节细胞向肠壁发出舒张的信号,大肠的这一区域就会收缩并变狭窄,从而堵塞了废物和气体通过的通道。当废物和气体在阻塞部位后面积聚时,大肠和腹部开始膨胀。婴儿可能会患上小肠结肠炎。然后,病变肠道可能会进一步伸展,导致呕吐和营养问题。患有先天性巨结肠的婴儿需要手术切除其病变大肠。在婴儿准备好做手术之前,需要进行灌肠。这个过程可以一天几次清除婴儿肠道中的气体和废物,有助于防止感染。巨结肠最常见的外科手术是腹腔镜辅助下经肛门拖出术。在手术过程中,医生将在婴儿的腹部做3~4个小切口,然后插入一个薄的、带有光源的摄像机和专门的器械。医生将使用这些器械松解并切除附着在身体上的病变肠道。为了切除病变的肠道,医生将在婴儿肛门内的直肠上做一个圆形切口。然后,将病变的肠道从婴儿的肛门中拖出并切除。将余下的健康肠道与肛门吻合。这个新的吻合将形成一个管道,可以彻底地将废物排出体外。手术结束时,医生将取出手术器械,并用缝线或皮肤封胶带缝合腹部切口。因为大部分的操作是通过肛门进行的,肛门外不会有要缝合的切口。

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