Precautions for postoperative care of colorectal cancer

For colorectal cancer, various drainage materials after surgery should be handled in time. The extraperitoneal negative pressure drainage tube for low anterior resection can attract bleeding and exudate in the pelvic cavity and presacral area. When no fluid is drained out, it is removed every 3 cm every day. The perineal packing gloves for abdominoperineal resection are generally removed 48 hours after surgery if there is no obvious bleeding. 24 hours after removal, flush the perineal cavity with 2500mL of 1:5000 warm potassium permanganate solution through a rubber tube, twice a day. After flushing, help the patient to drain the flushing fluid in the perineal cavity, and then cover the perineal wound with a sterile cotton pad and fix it with a T-belt. After the retained urinary catheter is removed, switch to a potassium permanganate solution sitz bath twice a day. The perineal negative pressure drainage tube is generally left in place for about 2 weeks until the fluid is completely drained and then removed. If the drainage fluid is found to be purulent, it means that the perineum is already infected. The drainage tube should be removed in advance, the perineal sutures should be removed, the perineal wound should be expanded, and the perineum should be flushed or bathed.

Indwelling a urinary catheter can prevent urine retention, preserve the tension of the bladder wall, and facilitate the early recovery of urination function. The urinary catheter should be connected to a sterile urine collection bottle with a sterile rubber tube, which should be replaced once a day and the sterile tube should be replaced once a week. It usually needs to be placed for about 2 to 3 weeks. Starting from the second week after surgery, the method of clamping the urinary catheter and intermittent open drainage can be used. If the residual urine volume exceeds 60mL, it often indicates severe damage to the posterior pelvic nerve plexus during surgery. During the period between indwelling catheterization, urine routine tests should be performed twice a week, and urine culture should be performed if necessary to understand whether there is a urinary tract infection.

For patients with colostomy, attention should be paid to the blood flow of the intestinal mucosa at the stoma within 1 week after surgery to check for bleeding, ischemia, necrosis, retraction or infection. The stoma sutures should be removed 9 to 10 days after surgery. If secondary infection occurs after the sutures are removed, the intestinal cavity should be filled with a small gauze strip containing antibiotic liquid to prevent stool from contaminating the wound. For patients with loop colostomy, the intestinal wall at the stoma is generally incised 48 hours after surgery to reduce the chance of fecal contamination of the incision. Before incision, cover the incision around the stoma tightly with vaseline gauze to prevent contamination of the incision and the abdominal cavity. The incision of the stoma intestinal wall is a circular full-thickness intestinal wall with a diameter of about 3 cm, so that feces can be discharged smoothly through the stoma.

After colostomy, the diet should consist mainly of low-residue and non-irritating foods to prevent diarrhea and cultivate the habit of regular bowel movements.