duodenoduodenal anastomosis

Duodenal duodenal anastomosis for the treatment of duodenal atresia and stenosis. Congenital intestinal atresia and intestinal stenosis are one of the common malformations in newborns. It occurs in the embryo 10 to 12 weeks, most of the vacuoles are formed by the epithelium-filled intestinal lumen, and the vacuoles fuse with each other to communicate with the intestinal lumen. This recanalization process creates an intestinal atresia or stenosis, duodenum. Occlusion and stenosis are mostly such embryonic malformations. In addition, when the fetus has developed completely after 3 months, during the intrauterine growth, due to different diseases such as volvulus, cable compression, intussusception, mesenteric developmental defects or mesenteric vascular embolism, intra-abdominal infection, etc. Causes of intestinal necrosis, perforation lesions, and then self-repair, which is the cause of the formation of empty, ileal atresia and stenosis, some patients can still see meconium peritonitis or meconium intestinal obstruction. Intestinal atresia and intestinal stenosis are most common in the lower jejunum and ileum, followed by the duodenum, which is less common in the colon. Mostly single lesions, but also multiple atresia. Treatment of diseases: duodenal injury Indication Surgery is the only treatment for congenital intestinal atresia and intestinal stenosis. If the intestine atresia is not operated in time, it will die about 1 week after birth, so it is ready to be operated as soon as possible after diagnosis. Intestinal stenosis is based on the condition and is actively prepared for surgery. Preoperative preparation 1, nasogastric tube decompression, to prevent vomiting and aspiration. 2, sick children often have pneumonia and atelectasis, need to fully inhale oxygen, sputum drainage, severe tracheal intubation, clear respiratory secretions, and give auxiliary breathing. Pay attention to the humidity of the inhaled gas. 3, pay attention to heat preservation, especially in low-temperature patients who are admitted to hospital, you must first restore your body temperature and then surgery. 4. Correct the imbalance of water, electrolytes, acid and alkali caused by frequent vomiting. 5. Application of antibiotics, vitamin K and vitamin C. 6, with blood 50 ~ 100ml spare. 7. Establish an intravenous infusion pathway. Surgical procedure 1. Incision A transverse incision can be used, 1 cm on the umbilicus, and the left end of the incision starts from 1 cm to the left of the midline. The incision is about 7 cm in length. It can also be a straight incision in the middle of the right upper abdomen or through the rectus abdominis. 2, free duodenum After the diagnosis of the abdominal cavity, the right colon is freed to move to the lower left. Open the duodenum and the posterior peritoneum, try to free the second part of the duodenum (kocher's manoeuvre). The third and fourth parts of the duodenum must also be fully freed behind the mesenteric vessels, and the duodenal jejunum When moving to the right side of the blood vessel, the above operations are generally not difficult. At this time, the proximal and intestine segments of the obstruction are fully revealed. At this point, you can see the cause of the obstruction. 3, draw near the intestine The side walls of the obstructed distant and intestine segments are brought together, and a needle thread is used to suspend the needle support line at both ends of the intestinal wall, and then the suture muscle layer is sutured between the needles. Parallel incision is made on both sides of the intestine wall, and the incision is about 1.5 to 2 cm long. 4, duodenal duodenal anastomosis The filaments were used as the full-layer intermittent suture of the anterior and posterior walls of the anastomosis. The needle spacing was 1 to 2 mm, and the needle was 1 mm apart from the cutting edge. The anterior wall can be sutured with a few needle muscle layers. Due to the small size of the distal intestine of the newborn, the two-layer anastomosis has certain difficulties. It is necessary to avoid the formation of stenosis and obstruction due to excessive varus. It is advocated to use single-layer suture, only one layer of full-thickness suture, and each needle should be in the intestinal wall. Turn it over. Regardless of the method of anastomosis, the appropriate fine needle thread should be used to make the operation meticulous and gentle, and try to avoid clamping the intestinal wall with the instrument. 5, gastrostomy and jejunal feeding tube placement In immature sick children, patients with severe disease, if necessary, add gastrostomy and jejunal feeding tube placement, the latter is more convenient when the anterior wall of the intestinal anastomosis is not anastomotic. The method is described in the anterior gastrostomy. 6, suture incision Abdominal wall incision suture, generally do not put abdominal drainage. complication 1, anastomotic obstruction: the reasons may be anastomotic edema, excessive varus, meconium obstruction and intestinal proximal resection is not enough, intestinal peristalsis is not good. If you have good decompression and nutritional support for intravenous or enteral feeding tubes, you can wait patiently and observe them. Otherwise, you must re-explore and correct within 1 week. 2, anastomotic leakage: for serious complications. In the case of nutritional support, a small intestinal leak is not accompanied by a manifestation of peritonitis, and sometimes non-surgical treatment can be cured. However, if the leakage is large and the peritonitis is obvious, it must be treated in time. 3, intestinal obstruction caused by intestinal adhesion: in children with meconium peritonitis is more likely to occur, non-surgical treatment is invalid when surgery is required. 4. Pneumonia: General respiratory infection or aspiration pneumonia are serious complications and must be actively prevented and treated. 5, a small number of patients with intestinal atresia did not find the diaphragm-type stenosis in the proximal side of the atresia, no complete obstruction in the early postoperative period, with the development of the sick child, dietary changes, symptoms or effects of incomplete obstruction after several months or even years It only appeared when nutrition was developed, and another operation was performed.