gastrinoma resection

Gastrinoma is characterized by hyperproliferative gastrinemia with a large amount of gastric acid secretion and refractory upper gastrointestinal ulcers, and some may be associated with diarrhea. A tumor that liberates gastrin is called gastrinoma. Gastrinoma derived from pancreatic non-B cells is now called ZES-II type, or pancreatic ulcer; it is called ZES-I type derived from hyperplasia or tumor of G cells in gastric antrum. Treatment of diseases: gastrinoma Indication The disease is feasible for medical treatment, but conservative treatment of internal medicine can not completely replace surgical treatment, and most patients eventually need surgery. Preoperative preparation 1. Correct water, electrolyte, acid-base balance disorder before surgery. Combined with anemia, preoperative blood transfusion corrected. 2. For those who have been violated by the transverse colon, preoperative bowel preparations such as oral enteric bactericidal drugs, cleansing enema, etc. are required. 3. Preoperative systemic use of antibiotics, usually started 3 days before surgery. 4. Prepare blood and prepare skin. 5. Insert the stomach tube. Surgical procedure 1. Incision: Take the upper midline incision, from the xiphoid to the umbilicus, when you need to expand, you can go down the left side of the umbilicus. If necessary, the xiphoid can be removed to increase the exposure of the surgical field. A chest and abdomen joint incision can also 2. Exploration: After entering the abdominal cavity, comprehensively explore the liver, gallbladder, pancreas, spleen, mesentery, pelvic cavity for metastasis. Finally, explore the lesion, determine its location, size, extent and its relationship with surrounding tissues and organs to determine whether to perform total gastrectomy 3. Isolation of the right ventricle of the gastric retina and the right ventricle of the stomach: the gastric ligament continues to be separated to the right, to the head of the pancreas and the duodenum, carefully separating the right movement and vein of the gastric retina, separating and cutting, using No. 7 Line ligation, line 4 stitching 4. Cut the duodenum: Take a non-invasive intestinal clamp and clamp the duodenum at 2.5 to 3 cm from the anterior pyloric vein. Clip a Kocher forceps at the proximal end and cut the duodenum between the two clamps. 5. Expose the fundus and lower esophagus: the right hand holds the left lobe of the liver, cuts the left triangular ligament, and the part of the blood vessel is cut and then ligated 6. splenectomy: If total gastrectomy is performed simultaneously with splenectomy, the splenic artery should be ligated at the upper edge of the pancreas. Free spleen around the spleen, separate the spleen, free spleen pedicle, spleen pedicle near the tail of the pancreas ligature, cut the spleen. 7. Cut off the cardia: Because there is no serosa in the lower part of the esophagus, only the muscle layer is left, and it is easy to tear when suturing. Therefore, a row of sutures can be sutured on the proximal full layer of the tangential line with line 1 to fix the esophageal muscle layer and mucous membrane. The esophagus was cut at a distance of 0.5 cm from the distal side of the suture, and the stomach tube was pulled out of the esophagus. 8. Excision and removal of the stomach: Turn the lower end of the stomach up and separate the fibrous tissue between the posterior wall and the pancreas. If splenectomy is not required, the gastric spleen ligament and the short gastric blood vessels are ligated and cut off, taking care not to tear the spleen capsule and damage the spleen pedicle. Remove the stomach. 9. Reconstruction of the digestive tract: There are many ways to reconstruct the digestive tract. Here are the common methods of esophageal jejunostomy and gastro-intestinal surgery. (1) jejunal esophagus-Roux-en-y anastomosis: the jejunum is cut 30 cm from the ligament of the flexor, and the treatment of the mesentery must ensure sufficient blood supply to the free jejunum segment. Generally, 2 to 3 blood vessel bows are cut off. A small segment of the avascular jejunum can be removed. (2) esophageal jejunostomy anastomosis: the jejunum was pulled from the transverse mesenteric incision to the lower part of the esophagus, and the jejunal muscle layer and the posterior esophageal diaphragm were sutured and fixed by the line 1, and then the esophagus and the jejunum were end-to-side anastomosed ( The method is the same as above), and the peritoneal and jejunal muscle layers of the lower esophagus are sutured to cover the anastomosis. (3) Single jejunum intercalation: The jejunum is lifted above the transverse mesenteric incision, and the jejunum of 15-20 cm is taken. The jejunum on both sides closes the mesentery to cut the mesentery, and a good vascular arch is reserved to supply the preserved jejunum. (4) Double jejunal replacement gastric stenosis: Free two jejunum with mesenteric fascia, take a segment of jejunum 25cm, one end is anastomosis with esophagus, then take a segment of jejunum inverted and end of duodenum, a large caliber between the two jejunum The side of the anastomosis, forming a jejunal bag, instead of the function of the stomach (Figure 36), it should be noted that the distance between the distal side of the jejunal jejunal anastomosis and the duodenal anastomosis should be about 5cm 10. Close the abdomen: clean the abdominal cavity, check the instruments, dressings, and close the abdominal cavity as usual.