1.What is the role of reflux enema for children with congenital megacolon? Congenital megacolon is usually treated by radical surgery, but reflux enema is very important for such children. Before radical surgery or preparation for radical surgery, it is necessary to correct the child’s general nutritional status, enema, anal dilatation, and open laxative, etc. Among them, reflux enema is an easy and cost-effective measure. It can effectively remove the accumulated feces, reduce the occurrence of small intestinal colitis, and is a necessary intestinal preparation before radical surgery. 2.What are the main points and methods of reflux enema? 1）Enema catheter: It is best to use double-lumen catheter, commonly used 20 or 26, double-lumen catheter has the risk of preventing inadvertent operation leading to the catheter all into the intestine. 2) Lubricant: Paraffin oil is generally used as a lubricant to facilitate the insertion of the enema catheter and reduce intestinal tube damage. (3) enema solution: saline is needed, and it is best to directly purchase physiological saline (0.9% physiological sodium chloride) prepared by pharmaceutical companies when available, or prepare it yourself when not available. Common physiological saline preparation method. j1 two (city two) salt (crystal salt or natural salt, iodized crystal salt and iodized natural salt does not affect the effect) added to 11 kg (city catty) of drinking water; k45 grams of salt added to 5000 ml of drinking water; l50 grams of salt added to 5500 ml of water; m1 two (city two) salt added to 330 ml of water = concentrated saline (spare, prohibited for enema, must be diluted with ), 30 ml of concentrated salt water down into 470 ml of drinking water = physiological saline (can be used for intestinal cleansing). Salt can be purchased from supermarkets with iodized or non-iodized crystal salt, sea salt, or natural salt. Own preparation of physiological saline must strictly follow the implementation of the concentration, saline concentration is too thick or too light can cause harm to children. (4) enema saline temperature: 38 ℃ ~ 38.5 ℃, need a thermometer to monitor the temperature of saline. (5) Enema method: gently insert the double-lumen urinary catheter of enema into the dilated colon through the anus (characteristics: breakthrough sensation, gas and stool flushed out from the catheter) and then slowly inject 15~30ml of saline with a syringe to dilute the stool and make the stool expelled (note: the amount induced should be greater than or equal to the amount injected). After the enema is completed, observe whether the abdominal distension is relieved, and preferably stay with the catheter for about 30 minutes before pulling it out. If necessary, dilate the anus and rectum for 5-10 minutes after pulling out the catheter, using the caudal finger (for small infants) and the index finger (for larger children) to dilate the anus and rectum to loosen the anus and rectum and promote intestinal contraction and peristalsis, so that the water remaining in the intestine after the enema can be discharged smoothly. Children with catheter insertion difficulties are recommended to dilate the anus first (dilate the anus and rectum for 5~10 minutes after lubricating the caudal finger with dilation strips or wearing gloves with paraffin oil). (6) Keep warm: infants have poor tolerance for cold and their body temperature is easily affected by the environment and changes, so attention should be paid to keeping warm during the bowel cleansing process, pay attention to measures such as increasing the room temperature and covering the clothes to avoid loss of body temperature and getting cold, so that the normal body temperature fluctuates from 36 to 37℃ and the anal temperature from 36.8 to 37.3℃. The process of bowel cleansing needs to strictly control the water temperature, especially in winter for young infants to avoid injury caused by too low or too high water temperature.