Ebook Netter’s surgical anatomy and approaches: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Netter’s surgical anatomy and approaches: Part 2
Ebook Netter’s surgical anatomy and approaches: Part 2
CHAPTERAbdominoperineal ResectionHarry L. Reynolds, Jr.INTRODUCTIONAbdominoperineal resection (APR) is most often employed for lower-third recta) canc Ebook Netter’s surgical anatomy and approaches: Part 2 cers with involvement ol the sphincters. Tumors above the levator muscles can typically be treated with sphincter-sparing techniques. Patients with anal squamous cell carcinoma refractory to, or who are not eligible for, chemoradiation may also be treated with APR. Occasionally, patients with inflam Ebook Netter’s surgical anatomy and approaches: Part 2 matory bowel disease and severe perianal disease may require an APR. This chapter describes a standard, reproducible reseaion technique.307308 SECTIONEbook Netter’s surgical anatomy and approaches: Part 2
5 LOWER GASTROINTESTINALPRINCIPLES OF PREOPERATIVE EVALUATIONThe patient is screened with a lull colonoscopy. Digital rectal examination and proctoscCHAPTERAbdominoperineal ResectionHarry L. Reynolds, Jr.INTRODUCTIONAbdominoperineal resection (APR) is most often employed for lower-third recta) canc Ebook Netter’s surgical anatomy and approaches: Part 2 vaginoscopy are performed with the proctoscope to assess for local invasion. CT scanning of the chest, abdomen, and pelvis is done to survey lor metastatic disease. Endorectal ultrasound is used lor staging to assess the need for preoperative chemoradiation (Fig. 25-1, B>.Pelvic magnetic resonance Ebook Netter’s surgical anatomy and approaches: Part 2 imaging (MRI) is increasingly used, providing a more complete and less operator-dependent pin lire of the extent of the tumor in the pelvis. MRI can pEbook Netter’s surgical anatomy and approaches: Part 2
rovide extremely useful information on circumferential mesorectal margins or frank involvement of the pelvic side wall, sacrum, or anterior organs. MRCHAPTERAbdominoperineal ResectionHarry L. Reynolds, Jr.INTRODUCTIONAbdominoperineal resection (APR) is most often employed for lower-third recta) canc Ebook Netter’s surgical anatomy and approaches: Part 2 bladder exists, indicating a need lor exenteration.Patients staged with clinical stage II or stage III tumors are usually treated with preoperative chemoradiation. Long-course therapy is routinely used, and surgery is typically performed 8 weeks after radiation therapy. The patient is reassessed wi Ebook Netter’s surgical anatomy and approaches: Part 2 th proctoscopy and the response to chemoradiation is noted. Some patients not thought to be candidates for a low anterior resection may be determinedEbook Netter’s surgical anatomy and approaches: Part 2
to be suitable for sphincter-sparing procedures when assessed after neoadjuvant therapy. Caution should be used in determining the extent of resectionCHAPTERAbdominoperineal ResectionHarry L. Reynolds, Jr.INTRODUCTIONAbdominoperineal resection (APR) is most often employed for lower-third recta) canc Ebook Netter’s surgical anatomy and approaches: Part 2 involved tissue en bloc. Microscopic deposits are frequently seen in deep specimens despite clear mucosa.CHAPTER 2 5 Abdominoperineal Resection aoyA. Rigid proctoscopy. CeiiorriK'd cm .ill patients with KMt.ll tuiniHs.I iK.itiun ÍKMII .in.ll vergp slxxild Ilf noted .It well as lot;«tion arid tumor Ebook Netter’s surgical anatomy and approaches: Part 2 < h.ir.M teiistii s prtcx to iXMkidjuv.int III suigK.ll tlxM.i|>y.B. Endorectal ultrasonography. A digital exam can determine tumor characteristics, lEbook Netter’s surgical anatomy and approaches: Part 2
ocal invasion, and fixation of tumor. Anatomic location of the tumor can help to predict possible invasion into prostate or vagina anteriorly, side waCHAPTERAbdominoperineal ResectionHarry L. Reynolds, Jr.INTRODUCTIONAbdominoperineal resection (APR) is most often employed for lower-third recta) canc Ebook Netter’s surgical anatomy and approaches: Part 2 age the tumor infiltratirxi t'T stage) as well as presence or absence of lithologic nodes. These findings will determine whether lhe patient is a candidate for surgical therapy ÍX neoadjuvant chemoradiation.transducerEndorectal ultrasonography assesses ■Itfxh Ilf turiHir perudraticxi and degree Ilf Ebook Netter’s surgical anatomy and approaches: Part 2 perirectal involvementUhtaMiixrgrarn. Rectal turiKX inv.iili*. [KMỨist.il fatUltrasonogram. Rectal tumor and involvement or perirectal lymph nodes tarEbook Netter’s surgical anatomy and approaches: Part 2
rows)Perirectal tatMuscularis/ fat interfaceMuscu larisMuscularis/ submucosa interfaceSullOKKXXUl/ mutXMia MucosaH:O balloon interface11.0ultrasound tCHAPTERAbdominoperineal ResectionHarry L. Reynolds, Jr.INTRODUCTIONAbdominoperineal resection (APR) is most often employed for lower-third recta) canc Ebook Netter’s surgical anatomy and approaches: Part 2 0 SECTION 5 LOWER GASTROINTESTINALANATOMIC APPROACH TO LEFTCOLON MOBILIZATIONThe left colon is mobilized just medial to the line of Toldt. preserving the fascia of the meso* colon. This approach allows a bloodless mobilization of the descending colon to the midline. The left gonadal and ureter arc e Ebook Netter’s surgical anatomy and approaches: Part 2 asily identified and protected throughout the dissection because they lie posterior to Toldt's fascia, which is kept intact over the ret rope ri toneEbook Netter’s surgical anatomy and approaches: Part 2
urn. If difficult to find, dissection either proximally toward the kidney or distally into the pelvis can assist in identifying the ureter.The mobilizCHAPTERAbdominoperineal ResectionHarry L. Reynolds, Jr.INTRODUCTIONAbdominoperineal resection (APR) is most often employed for lower-third recta) canc Ebook Netter’s surgical anatomy and approaches: Part 2 s of the sympathetic nerves, which lie deep to the IMA, are protected by keeping close to the fascia of the mesocolon as it wraps around the IMA, if necessary sweeping nerve branches dorsally and away from the vessel (Fig. 25-2, fl). The IMA is isolated, damped, and ligated. Tile left colic artery a Ebook Netter’s surgical anatomy and approaches: Part 2 nd the inferior mesenteric vein are divided and ligated at the level of the IMA (Fig. 25-2. C). The mesentery is divided perpendicularly to the levelEbook Netter’s surgical anatomy and approaches: Part 2
of the marginal artery, just proximal to the 1st sigmoidal branch. Unlike in low anterior resection, where extra length is needed for a tension-free cCHAPTERAbdominoperineal ResectionHarry L. Reynolds, Jr.INTRODUCTIONAbdominoperineal resection (APR) is most often employed for lower-third recta) canc Ebook Netter’s surgical anatomy and approaches: Part 2 onstruction.CHAPTERAbdominoperineal ResectionHarry L. Reynolds, Jr.INTRODUCTIONAbdominoperineal resection (APR) is most often employed for lower-third recta) cancGọi ngay
Chat zalo
Facebook