Esophagojejunostomy with total gastrectomy

Treatment of diseases: gastrointestinal cancer Indication Gastrointestinal jejunostomy with total gastric resection is applicable to: Total gastrectomy is indicated for the treatment of gastric cancer with a wide range of lesions that have not been invaded into the liver, peritoneum or Douglas sag, or for the control of pancreatic non-B-cell carcinoma with ulcer disease. Contraindications Gastric cancer has metastases in the liver, peritoneum, or Douglas lacuna, or in patients with poor general condition. Preoperative preparation 1. Strengthen nutrition and give high fat and high protein diet. Due to the difficulty of swallowing, it often affects the general condition of the patient. A small number of patients can increase their body weight by 2 to 3 kg within 2 weeks after completing preoperative radiotherapy to relieve the obstruction. 2, to help patients increase the amount of activity to enhance physical fitness, practice urination in the bed and effective cough. 3, strengthen brushing mouth, pay attention to oral hygiene. 4, severe obstruction, starting 3 days before surgery, use the catheter to wash the esophagus before going to sleep at night. 5. Prepare the skin 1 day before surgery. 6, enema one night before surgery, given sleeping pills. The stomach tube was taken on the morning of the operation, and the medicine was administered before the injection. 7, patients preparing for colonic esophagus should be prepared for the bowel, the method is: 3d before surgery to a semi-flow diet, 1d before surgery into the flow of food. Oral streptomycin 0.5g, metronidazole 0.4g, 3 times a day, 3 times before surgery, vitamin K was given at the same time. Another way to quickly prepare the intestines is to enter the food 1d before surgery, clean the enema one time at night and on the morning of the operation, and take 1g of neomycin and 1% of the nitric acid at 1st, 3rd, 5th, and 7th in the afternoon before surgery. Oxazole 0.4g. Surgical procedure 1, the patient took the right lateral position, the left chest posterolateral incision, the left 8th rib was removed, and the chest was inserted through the 8th ribbed bed. Or the left chest and abdomen combined incision, through the 7th or 8th intercostal space into the chest. 2, the first exploration, such as the discovery of cardiac cancer has affected the fundus and most of the small curved side of the stomach, proximal gastrectomy can not completely remove the tumor, feasible total gastrectomy (total gastrectomy). The scope of total gastrectomy should include the lower esophagus, total stomach, omentum, omentum, and abdominal lymph nodes, and the spleen should be removed if necessary. If the cancer is involved in the transverse colon or pancreatic tail, part of the colon or pancreatic tail can be removed at the same time. 3. Remove the resected specimen and routinely suture the duodenal stump. The esophagus-jejunum Roux-en-Y anastomosis was performed with an EEA stapler. 4, lift the jejunum, cut the Treitz ligament, cut the jejunum about 30 ~ 35cm from the ligament, clamp, cut and ligature the grade 1 vascular arch in the jejunum mesangium, retain a certain blood vessel branch. 5, in the colonic arterial avascular zone of the transverse colon mesenteric to do all the mouth, the distal end of the jejunum through the incision to the chest cavity, ready for end-to-end anastomosis with the esophagus. 6. Insert the nail head of the stapler without the nail base into the intestinal cavity of the distal end of the jejunum, and make a small incision with a sharp blade on the side wall of the side wall of the mesenteric edge about 5 cm from the broken end. The center rod of the stapler is led out through the small incision. 7. The proximal end of the esophagus is made with a purse-stitching device or a manual continuous-wound full-layer suture method. The needle spacing is 2 to 3 cm, and the general sewing is 8 to 10 needles. 8. Install the abutment on the central rod, and insert the anvil with the center rod into the esophageal cavity near the proximal end of the esophagus; tighten the purse string and tie it, so that the stump of the esophagus is fixed in the stapler. On the center pole. The suture and ligation of the purse string should be secure and secure to prevent the esophageal stump from slipping off. 9. Gradually tighten the screw knob at the end of the main body of the stapler to adjust the distance between the abutment and the nail head, so that the aligned jejunal wall and the esophageal stump are aligned and closed. 10, firing the stapler, complete the esophageal - jejunal end side of the cutting and mechanical anastomosis. The size of the anastomosis is determined by the size of the head. If 28mm nail head is used, the inner diameter of the anastomosis is 18mm; if 25mm is used, the inner diameter of the anastomosis is 15mm. 11. Loosen the screw knob at the end of the stapler and push the distal end of the jejunum upwards. Exit the stapler from the distal end of the jejunum and examine the cut tissue ring (ie, the esophageal ring on the removed central rod and The jejunal wall excised by the circular cutter is intact, and the left hand is inserted into the distal lumen of the jejunum to the anastomosis for palpation. If the palpation or gas injection test shows that the anastomosis is defective or leaking, The jejunal distal end of the jejunum was closed with a gastrointestinal suturing device (GIA). 12, around the anastomosis with a thin wire line muscle layer intermittent suture method for 1 week. 13. The proximal end of the jejunum is end-to-side anastomosis with the distal end of the jejunum. 14. After the end of the anastomosis, the diaphragm is sutured, the esophageal hiatus is sutured around the jejunum, and the incision of the transverse mesenteric and the jejunum are fixed by intermittent suture to avoid internal hemorrhoids. 15, routine placement of chest drainage, layer by layer chest (abdominal).