Lifting jejunostomy

The small intestine is an important digestive organ, from the pylorus to the ligament of the genus Duodenum, from the ligament of the flexor to the ileum and the ileum. The length of the small intestine varies with age, and the individual differences are quite large. The mesentery of the jejunum and ileum adheres to the posterior abdominal wall, starting from the left side of the second lumbar vertebrae and ending in front of the ankle joint. The jejunum accounts for about 40% of the small intestine and the ileum accounts for 60%. There is no obvious boundary between the two. Generally speaking, the diameter of the jejunum is larger, the intestinal wall is thicker, and the jejunum mesentery has only one layer of vascular arch; while the ileal intestinal wall is thinner and thinner, and the mesenteric vascular arch is composed of 3 to 4 layers of arterial arch. This can be used to determine the approximate position of the small intestine during surgery. The main physiological function of the small intestine is to digest and absorb nutrients, and the small intestinal juice contains various enzymes. After the small intestine stoma, it is easy to cause digestive dysfunction and water and electrolyte disorders, resulting in dehydration of sick children. Setting too many small intestines can cause severe malnutrition. Therefore, small intestine ostomy should strictly control the indications. Once the condition of the sick child is allowed, the stoma should be closed as soon as possible to reduce complications. Curing disease: Indication Lifting jejunostomy is suitable for patients with esophageal, gastric and duodenal lesions, long-term inability to eat by mouth, and unconditional long-term parenteral nutrition, feasible lifting jejunostomy, In order to enter a fluid diet to maintain nutrition. Preoperative preparation 1. When toxic shock is combined, it should be immediately treated with anti-shock treatment and rescued while preparing for surgery. 2. Immediately check blood routine, blood biochemical examination, such as potassium, sodium, chlorine, carbon dioxide combined carbon binding capacity, urea nitrogen, blood gas analysis, hematocrit, to understand the degree of blood concentration and the degree of water and electrolyte imbalance, Formulate preliminary rehydration measures and plans. 3. Immediately open the venous channel. When the shock is severe, it can be venous incision and rapid infusion to rapidly improve dehydration and acidosis. Transfusion or plasma if necessary to increase colloid osmotic pressure. 4. Place the stomach tube and perform gastrointestinal decompression. Vitamin B1, vitamin C and vitamin K are added. 5. Apply antibiotics. Surgical procedure The incision is the same as the tunnel jejunostomy. After laparotomy, the upper part of the jejunum is raised outside the incision, and the intestine wall on the opposite side of the mesentery is double-layered, and a small hole is punched in the center of the inner purse with a sharp knife. The mushroom-like stoma is inserted into the jejunum 5 cm (with nutrition). Sexual jejunostomy), tighten the purse string. Then, the peri-intestinal wall muscle layer and the peritoneum were sutured for several needles. The ostomy tube is drawn from the puncture hole in the center of the suture. The intestinal wall around the stoma is stuck to the abdominal wall, so the small intestine does not retract. However, after the extubation, the abdominal wall stoma healed slowly. In some cases, the adhesion must be separated by surgery, and the small intestine stoma can be healed. complication 1. Postoperative intra-abdominal and incisional infection leads to abdominal wound splitting The prevention method is: 1 high-risk children are estimated to have a possible incision in the postoperative incision, and should be given intraoperative suture reduction; 2 active supportive therapy, including input of protein, plasma and whole blood, while early infusion of nutrient solution and Other high-calorie, high-vitamin diets; 3 use effective antibiotics to prevent infection of the abdominal cavity and incision; 4 maintain gastric tube patency after surgery to reduce abdominal distension; 5 maintain water and electrolyte balance to promote wound healing. 2, stoma intestinal prolapse The prevention method is that the puncture of the abdominal wall fascia through the stoma can not be too large; the muscle wall of the stoma wall should be properly sutured with the peritoneal layer, fascia and skin. 3, stoma stenosis Caused by scarring of stoma scar tissue. Prevention: The stoma should not be too tight and too small, and it will be expanded 2 weeks after surgery. 4, stoma intestinal retraction Due to the short small mesentery, sustained traction after surgery. Another reason is that the intestine remains too short outside the abdominal wall. After the bowel retraction, the abdominal wall should be re-surgically pulled out and properly fixed. 5, intestinal obstruction It is more common in the adhesion of the adhesive tape after the adhesion of the intestine, and sometimes it can be seen that the intestine is twisted by the stoma. Once an obstruction occurs, the obstruction should be removed in time.