rectal instruments

OPERATIONS FOR VILLOUS AND NONMALIGNANT TUMOURS OF THE RECTUM


By • Дек 26th, 2010 • Category: Rectum

After that the swab holder is withdrawn, and the po­lyp pedicle grasped with the forceps’tip (Fig. 124.3) and cauterized. The tumour should be either removed or will «shell out» spontaneously.

To remove large pedicled polyps, we make use of a special proctoscope tube designed by us which is 22 mm in diameter, i. e, 4 mm longer than the ordinary tube. This permits the polyp to be grasped and drawn taut with one forceps and to compress its neck with another one, (Fig. 125), after which the first forceps is withdrawn and the neck cauterized.

OPERATIONS FOR VILLOUS AND NONMALIGNANT TUMOURS OF THE RECTUM

Villous tumours are of very soft consistency and dis­charge mucus profusely. Their size varies from 3 to 6 cm in diameter, although larger tumours are occasional­ly encountered (10 to 12 cm in diameter).

These tumours are characterized by a tendency to ma-lignisation evidenced by induration and superficial ulce-ration.

Four types of operation are performed for villous and other benign tumours of the rectum (such as fibroma, lypoma, angioma, etc.); (1) excision per anum; (2) elec-trocoagulation; (3) posterior proctotomy (rectotomy); and (4) colotorny by the abdominal route when the sig-moid is affected).

Excision per anum is resorted to when willous tu­mours are located not more than 10 cm from the anus. The operative procedure is identical to that used to re­move polyps (see Figs 122,1 and 122,2).

The tumour is grasped with a fenestrated forceps, drawn upwards, and its base is exposed. The base is then com­pressed by means of a Billroth forceps. The tumour is excised above the forceps (Fig. 126,1), the mucosa over-the forceps is sutured with catgut, the forceps is pulled out, and the suture tied up. Thus, by grasping the base of tumour in turn with the forceps and suturing the mu­cosa, the tumour is completely removed (Fig. 126,2).

Electrocoagulation of \illous and other benign tu­mour is done when the tumour is situated 8 cm from the anus and has the diameter of 2 to 3 cm. If the tu­mour has a pedicie, then procedure for electrocoagula-tion is identical to that illustrated in Figures 124,2 and 124,3 (pp. 147—149).

When a flat creeping tumour is present, electrocoagu-lation is performed by touching the whole tumour sur­face gradually with the electrode (Fig. 127).

Polyp electrocoagulation through a proctoscope with a large-diameter tube

Operation for villous tumour of the rectum

Fig. 124. Polyp electrocoagulation through a proctoscope:

3. The polyps pedicle is cauterized.

Fig. 125 Polyp electrocoagulation through a proctoscope with a large-diameter tube.

Fig. 126. Operation for villous tumour of the rectum:

1. The tumour has been drawn upwards, and the pro­ximal part of its base is excised above the Billroth for­ceps. A catgut ligature has been passed under the for­ceps.

2. The villous tumour has been removed. Mucosal su­tures can be seen at the site of the former base of the tumour.

Fig. 127. Electrocoagulation of tumour surface.



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