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Surgery cooperation norms for radical resection of colon cancer

  1. Indications
  2. Proximal colon (cecum, ascending colon, transverse colon) cancer.
  3. Distal colon (descending colon, sigmoid colon) cancer.
  4. Patients with no distant metastases such as liver or lung and intraoperative peritoneal metastasis in B-ultrasound and CT examination before operation.
  5. There is no severe heart, lung, liver, or kidney insufficiency.
  6. Operation method
  7. Radical right hemicolectomy
  8. Radical transverse colectomy
  9. Radical left colectomy
  10. Radical sigmoid colectomy
  11. Radical total colectomy
  12. Anesthesia: general anesthesia

Fourth, surgical position

  1. Radical resection of the right colon, transverse colon, and left colon (the tumor is located near the splenic flexure) in the supine position
  2. Radical sigmoid colon (tumor is located on the distal side), total colectomy with lithotomy position

Five, preoperative preparation

  1. General equipment and materials: general equipment package, surgical dressing package, laparotomy dressing package, rectal single package. 22# blade 11# blade 3-0#2-0#0#丝线14# urinary tube urine bag 20ml syringe aspirator tube aspirator head glove electric knife.
  2. Special instruments and objects: large purse-string pliers, 64mm purse-string, ultrasonic knife
  3. Prepare according to doctor’s advice: use Hemlock forceps for abdominal laparotomy, Hemlock (544243, 544253) Xinpihu (180MM) stapler, closure, cutting stapler, staple cartridge, antibiotics, chemotherapy drugs
  4. Special equipment: ultrasonic knife 23CM, high frequency electric knife
  5. Itinerant nurses: check whether all the instruments and equipment in the operating room are in good condition and in standby state, check patients, establish intravenous access, and strictly implement the tripartite verification system before anesthesia
  6. Matters needing attention: Reverse verification should be used when verifying the identity of the patient, and at least two verification methods should be used. Pay attention to verify the label of the surgical site, and sign the surgical safety checklist in time

Six, set-up specifications

  1. Surgical steps and cooperation (taking radical right hemicolectomy as an example)
  2. Skin disinfection and disinfection methods: 2% iodine twice, 75% alcohol deiodine twice, and perineal iodine disinfection twice. Disinfection range: from the bottom of the nipple to the upper 1/3 of the thigh to the mid-axillary line and the perineum. Instrument nurse: prepare disinfectants (three iodine cotton balls in the small blue bowl, five alcohol cotton balls in the big blue bowl, two iodine cotton balls in the curved plate, 2 sponge forceps); then check the dressings with the visiting nurse : Two people sing points according to the cards in the equipment. After the inventory is correct, the pre-division of instruments: 6 middle bends, 2 needle holders, 2 leather tweezers, 1 scissors, small knife handle No. 11 blade, a set reserved on the side of the sterile table away from the surgical area, covered by the treatment towel spare. Inside the isolation tray: spread treatment towels, 2 large straight forceps and 3 tissue forceps. Itinerant nurse: assist the surgeon to correctly position the patient, maintain the functional position, and avoid excessive pulling of blood vessels and nerves; cooperate with the hand-washing nurse to open various items needed for the operation; choose the muscle-rich place to paste the electrosurgical negative plate; count the number of equipment dressings, duo Record the points one by one; if it is a stone cutting position, you should prepare a silicone pad and a posture frame in advance, and remove the head plate; standardize the use of antibiotics.
  3. Spread sterile sheets in the order of use and deliver sterile sheets such as treatment towels to assist doctors in spreading sterile sheets. Put on a sterile film. Instrument nurse: prepare 4 treatment towels, covering the incision in the order of perineal side-contralateral side-head side-proximal side. The first layer of treatment towel is handed to the doctor’s shop (the first treatment towel is folded inward, the second treatment towel is folded outward, the third treatment towel is folded inward, and the fourth treatment towel is folded inward) , And then lay the surgical drapes with the surgeon who put on sterile gowns and sterile gloves, in the same order as the treatment towel, covering the anesthesia head frame and the side of the foot. Note: When handing the treatment towel, the surgeon’s hands must not touch the hands of the hand washing nurse; when placing the surgical drape, turn it inward to cover the back of the hand and not expose it; the surgical incision and instrument tray should cover at least 4-6 layers ; The transparent film sticks smoothly and without bubbles.
  4. Connect the electric knife, aspirator, and ultrasonic knife to the instrument, and fix it properly. Device nurse: Properly fix it to prevent the patient from being pinched. Do not wind the electric knife cord around metal instruments. Install the ultrasonic knife correctly, and spare it for self-check. Itinerant nurse: Connect the electric knife and ultrasonic knife, and adjust the power from low to high. Connect the suction tube and turn on the shadowless lamp to fully illuminate the surgical area.
  5. Open the abdomen: take the midline incision on the right side, and cut the skin with the 22nd knife. The electric knife cuts the subcutaneous tissue, the anterior and posterior sheath of the rectus abdominis and the peritoneum. Instrument nurse: accurately pass 22# blade-leather tweezers-electric knife pen-large curved pliers-gauze. Replace the open gauze. Note: The electrosurgical cap, iron wire, and the visiting nurse will check and deal with them. The sharps are transmitted without contact; the nurses, anesthesiologists, and surgeons in the operating room once again check the patient’s information together before the operation.
  6. Exploring the abdominal cavity: install an incision protector, if the tumor breaks through the serosal surface, do a sealing treatment, and replace the gloves after the exploration. Instrument nurse: prepare incision protector, automatic pull hook, suspension hook, abdominal cavity pull hook, and prepare deep instruments. Prepare to replace the required gloves. Note: Check the integrity of the incision protector and the automatic pull hook before use. Itinerant nurse: Use chemotherapy drugs as directed by your doctor. Remind the doctor to change gloves. Check the specifications and models of the incision protector in advance.
  7. Separate the right peritoneum and free the right colon. Instrument nurse: pass the large curved forceps, electric knife, and ultrasonic knife in turn. Spare pliers with No. 4 silk thread.
  8. Dissociate the roots of the right mesocolon, cut off the main vascular trunks that innervate the corresponding intestinal segments (ileocolonic arteries and veins, left colonic arteries and veins, right branch of the middle colonic arteries and veins), free with large curved vascular forceps, electric knife, ultrasonic knife No. 1 silk thread ligation or small round needle No. 4 silk thread ligation. Instrument nurse: accurately deliver large curved forceps, electrosurgical knife, and ultrasonic knife. Prepare pliers with No. 4 silk thread (or No. 1 silk thread) and small round needle No. 4 silk thread. Handling blood vessels: vascular forceps-electrosurgical knife or tissue cutting off-4th silk thread ligation-thread cutting. Itinerant nurse: According to different positions operated by the surgeon, adjust the light and electric knife power in time. Prepare Hemlock according to the habit of the surgeon.
  9. Free the right mesocolon and greater omentum: Use greater curved vascular forceps, electrosurgical knife, and ultrasonic knife to free it. No. 4 silk thread, No. 1 silk thread ligation or small round needle No. 4 silk thread ligation. Instrument nurse: accurately transfer large curved forceps-electric knife, ultrasonic knife. Prepare pliers with No. 4 silk thread (or No. 1 silk thread) and small round needle No. 4 silk thread. Handling blood vessels: vascular forceps-electrosurgical knife or tissue cutting off-4th silk thread ligation-thread cutting. Itinerant nurse: communicate with the surgeon in advance about the model of the stapler and turn it on for use. Prepare purse-string pliers and purse-string for spare.
  10. Resection of the right colon and the mass: the proximal end is 10cm away from the ileocecal area from the severed ileum, and the distal end is 10cm away from the lower edge of the tumor. Instrument nurse: add a sterile sheet and put an isolation disc on the end. Proximal end: small purse-string pliers-purse string-large straight pliers-electrosurgical disconnection-iodophor cotton ball disinfection of intestines-tissue forceps 3 holding intestinal lumen-put into the stapler at the bottom of the stapler. Far end: large straight pliers-extra large bend-electric knife cut off-iodophor cotton ball disinfection. Prepare the specimen basin to collect specimens. Strictly implement surgical isolation techniques. Pay attention to the number and completeness of disinfection cotton balls. Itinerant nurse: prepare stump closure or linear cutting closure according to doctor’s order. Communicate with the surgeon in advance to prepare the stump closure.
  11. Anastomosis of the intestine and embed the anastomosis: the distal end of the stump is inserted into the stapler gun, and after the proximal end is anastomosed end-to-side, the stump closer closes the distal stump, and the small round needle No. 1 silk thread embeds the anastomosis and the broken end. Instrument nurse: 3 tissue forceps (distal broken ends)-iodophor cotton ball sterilization-stapler gun anastomosis-closing device closed stump-iodophor cotton ball disinfection treatment towel stapler, confirm whether the stapler is cut completely. Remove the isolation tray and the sterile sheet added. Small round needle No. 1 silk thread is embedded. The needles and instruments used for embedding the stump should not be used for other operations. Itinerant nurse: Prepare sutures for embedding as directed by the doctor. Prepare anastomosis objects in advance according to the anastomosis method.
  12. Close the mesentery and arrange the small intestine homing equipment. Nurse: Prepare small round needle No. 1 silk thread
  13. Flush the abdominal cavity, check hemostasis, replace the gauze and equipment. Nurse: count the equipment, remove the equipment and items in the surgical field, prepare 37-42℃ distilled water, replace all the equipment, needles, and gauze after washing, wipe the electric knife handle, and add Spread sterile towels and use the reserved instruments to perform the following operations after changing gloves. Itinerant nurse: Pay attention to the temperature of the washing fluid and strictly implement the inventory system. Prepare 37-42℃ warm distilled water. Remind the surgical staff to use the reserved instruments to perform the following operations after changing their gloves.
  14. Placement and fixation of drainage tube equipment nurses: surgical staff change gloves and add sterile sheets. 11#Blade—2 large curved pliers—drainage tube—large leather needle No. 4 silk thread to fix. Spread the treatment towel and replace the equipment. Verify the side hole fragments of the drainage tube cutter. Itinerant nurse: prepare a suitable type of drainage tube according to the needs of the surgeon.
  15. Close 6 middle peritoneal curved forceps, large round needle No. 7 silk suture, 1 large forceps, and check the dressings. After the instrument nurses and the visiting nurses count the instruments and items together, prepare sutures according to the needs of the surgeon. Before and after closing the body cavity, count in time after sewing the skin. Before and after closing the body cavity, count in time after sewing the skin, and inform the doctor after correctness.
  16. Suture the front sheath with a large round needle No. 7 silk suture. 16. Suture the skin with alcohol cotton ball to sterilize the skin, use 2 skin tweezers and suture with a large skin needle No. 4 silk thread. The application covers the incision. Before and after closing the body cavity, count in time after sewing the skin, and inform the doctor after correctness. After the instrument nurses and the visiting nurses count the instruments and items together, prepare sutures according to the needs of the surgeon. Before and after closing the body cavity, count in time after sewing the skin. Before and after closing the body cavity, count in time after sewing the skin, and inform the doctor after correctness.

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