Esophagogastric anastomosis

The cause of this disease is not clear, and the basic defect is neuromuscular abnormality. It is generally believed that the ganglion degeneration, reduction or disappearance of the esophageal muscular layer of the disease, and the distribution of the parasympathetic nerve (vagus nerve) are defective. The distal end of the esophagus has a narrow stenosis of 1.5 to 5 cm in length, and the proximal esophageal body has different degrees of expansion, extension and bending. Because of the hypertrophy of the esophageal ring muscle, the distal esophageal wall can be thickened, but occasionally there is atrophy. The normal driving force of the esophagus and the lower esophageal sphincter cannot relax as expected. When swallowing, the esophageal smooth muscle relaxes, the peristalsis is weak, and the lower esophageal sphincter has a large tension and cannot be loosened, so that the food can stay in the esophagus and cannot descend. For a long time, the esophagus expands, stretches, bends into an angle, loses muscle tension, and the peristalsis is clonic and has no driving force. As food retention stimulates the esophageal mucosa, inflammation and multiple ulcers follow. On the basis of stagnation esophagitis, cancer can occur, the incidence rate can be as high as 2% to 7%, mostly at the junction of the middle and lower middle esophagus. Due to the dilatation of the esophagus, the symptoms of obstruction after canceration appear later, and it is difficult to remove most of them when found. Those who can be resected have a poor prognosis, and most of them die due to metastasis. Treatment of diseases: congenital esophageal stricture Indication 1, the esophagus is over-expanded, the myometrial fibrosis is severe, the submucosal adhesion is tight, and the myometrial incision can not achieve the purpose of release. 2. Symptoms recurred after esophageal muscle incision. 3. When the myometrial incision is performed, the mucous membrane is broken, and the crack is too large to be repaired. Contraindications 1. Those with severe heart and lung function. 2, nutritional status is low, hemoglobin is less than 6.0g / L. Preoperative preparation 1, those with malnutrition, should be corrected before surgery, can be intubated through the central vein, parenteral nutrition support or medical treatment or dilatation treatment, so that it can be oral into the liquid food. 2. Patients with pulmonary complications should be treated appropriately. 3, because the food is retained in the esophagus, the esophagus has different degrees of inflammation, the esophagus should be inserted into the stomach tube once a day for 3 days before surgery, and the antibiotic solution is injected after washing. Repeat 1 time before anesthesia to remove the accumulated secretions overnight and leave the stomach tube. Premedication should not be given to pills or tablets. Surgical procedure 1. The posterior lateral incision of the left chest enters the chest through the 7th or 7th intercostal space. 2, cut off the lower lung ligament until the level of the lower pulmonary vein, longitudinally cut the mediastinal pleura, free the lower end of the esophagus, with the gauze to pull the esophagus, explore the esophageal stenosis. 3. Cut the diaphragm along the esophageal hiatus, freely cut off the short gastric artery, so that the fundus can be lifted up. The esophageal muscle layer near the lower end of the esophagus and the muscle wall of the stomach wall are sutured intermittently, and the suture is not penetrated into the cavity. The stenosis of the esophageal and sacral sacs was completely cut at a width of 1 cm from the suture, thereby extending to both ends, and the incision was about 5 to 7 cm long. If the myometrial fibrosis is severe in the esophageal cardia, the esophagus can be cut over the stenosis area, so that the food after the anastomosis bypasses the cardia and directly enters the stomach. Make the same longitudinal incision in the stomach wall of the corresponding area of the esophagus. 4. The gastric and esophageal cutting edge is sutured from the midpoint of the incision to the ends. Turning to the front at the corners of both ends, the front wall is stitched by the inversion stitching method, and the stitches at both ends meet at the midpoint of the incision. The anterior wall is further sutured and sutured. The suture of this layer only passes through the esophageal muscle layer and the sarcolemma layer, and does not pass through the cavity. One stitch at each end of the slit is reinforced by a needle. 5. Or cut the whole layer of the esophageal stenosis and extend it to the bottom of the stomach to form an arc-shaped incision. Before the esophagus is cut, a gauze can be ligated above the incision to prevent the esophageal contents from flowing out. A rubber sheathed intestinal forceps can also be placed under the fundus incision to prevent the contents of the stomach from flowing out. The posterior wall esophageal muscle layer and the gastric pulp muscle layer were sutured intermittently, and then the whole layer was sutured from the lower end of the esophageal incision. The anterior wall was sutured by the anterior wall and the anterior wall was used for the gastric mucosal and esophageal muscle layer. . 6, reconstruction of the esophageal hiatus, the diaphragm and the esophagus, around the stomach to prevent the occurrence of sputum. complication Gastroesophageal reflux and reflux esophagitis. If you have symptoms, you can take antacid treatment.