proximal partial gastrectomy

Partial proximal gastric resection is performed after the proximal stomach and the gastric cardia are removed, and the distal end of the stomach is anastomosed to the esophagus. This procedure can be performed by abdominal, transthoracic or transthoracic and abdominal incision. Treatment of diseases: gastric cancer and cardiac cancer Indication Proximal gastric partial resection is applicable to: 1. Tumors in the proximal and distal part of the corpus, including gastric cardia cancer and large benign gastric tumors. Radical proximal gastrectomy should be performed for the treatment of cardiac cancer. 2, gastric and cardia ulcers, medical treatment is invalid or blood and perforation. 3, portal hypertension, gastric fundus or esophageal varices bleeding or cardia mucosal tears complicated with upper gastrointestinal bleeding. Preoperative preparation 1. Patients with poor general condition and nutritional status should improve their general condition before surgery to correct malnutrition, anemia and hypoproteinemia. A diet high in protein and sufficient vitamins should be given. If necessary, transfusion or plasma transfer should increase the levels of hemoglobin and plasma protein. 2, patients with dehydration and electrolyte imbalance should be properly infused and supplemented with electrolytes before surgery to correct water and electrolyte disorders. 3, patients with pyloric obstruction should start fasting, gastrointestinal decompression, infusion, daily gastric lavage 2 or 3 times before surgery, emptying the food and secretions in the stomach, reducing inflammation of the gastric mucosa And edema to facilitate recovery after surgery and surgery. 4, patients with ulcer bleeding should take a variety of anti-shock measures before surgery, active blood transfusion, try to fill the blood volume. 5, patients with elective surgery 1 hour before the operation of soapy water enema 1 time, fasting the morning of surgery, insert a nasogastric tube. Surgical procedure 1, the upper abdomen midline incision, the upper end of the incision should exceed the xiphoid 1 ~ 2cm. If necessary, the xiphoid process is removed and the lower end is wound under the navel. The upper end of the incision was retracted with a chain retractor and the sternum and ribs were lifted to reveal the underarm area. 2. After detecting the clear lesions in the abdominal cavity, the proximal stomach is released. The gastric collateral ligament was dissected along the large curvature of the stomach and released to the left side. The gastric branches of the left ventricle of the gastric retina were separated one by one, and then ligated after cutting (for example, the omentum should be removed for cardiac cancer). At the bottom of the stomach, the spleen and stomach ligaments are cut one by one to ligature the short blood vessels of the stomach until the His triangle of the gastric cardia. Then, the small curved side of the proximal stomach was dissected, and it was cut in the avascular region of the small omentum, and separated along the small curvature of the stomach to the left side. The left gastric blood vessel was released on the inner side of the small curved stomach of the Qimen, and the ligation was cut after clamping. The sacral esophageal ligament was cut transversely above the cardia, and the front and the sides of the lower end of the esophagus were freed. The vagus nerve was placed close to the anterior wall of the lower end of the esophagus, and the vagus nerve was dissected and then ligated. Then, the operator uses the right-hand index to separate from the left side of the lower esophagus along the posterior wall of the esophagus to the right side, and the loose tissue between the back of the esophagus and the tendon is easily separated. After separation, a band is used to bypass the lower end of the esophagus for traction, and is separated upward along the esophageal wall, and the lower end of the esophagus is 5 to 7 cm. The large curved side of the stomach and the bottom of the stomach are turned to the right side, and the adhesion of the posterior wall of the stomach to the pancreas is separated, and the posterior gastric blood vessels from the upper edge of the pancreas are cut and ligated. 3. A toothed vascular clamp is placed on the cutting line on the large curved side of the stomach, and the length of the clamp is about 4 cm. An XF90 on the small curved side of the stomach is connected to the tip of the toothed vascular clamp, and the distance is adjusted to "fire". The proximal corpus of the corpus corpuscles was cut along the XF and the proximal side of the vascular clamp to remove the XF. If there is a bleeding point in the gastric stump, use a thin line to make an "8" shape suture to stop bleeding, and then suture the muscle layer intermittently. 4. Drag the nasogastric tube up into the esophagus, cross the esophagus on the cardia, and remove the proximal stomach tissue. A 6-0 non-absorbent line was used along the edge of the cut end of the esophagus to make a continuous wound around the side of the purse. 5, release the vascular clamp of the stump of the large curved side of the stomach, suture the 4-needle traction line at the edge of the stump, and use the vascular clamp to enter the gastric cavity through the gastric stump, 3~4cm from the stump of the posterior wall of the stomach. Poke a small mouth, insert the center rod of the GF into the needle seat through the small hole and then extend from the stomach stump. The operator holds the center rod, puts the needle seat into the end of the esophagus, and tightens the suture line. The esophageal wall is evenly wrapped around the needle seat, and the GF body is placed on the center rod, and the center rod is inserted into the stomach cavity. Rotate the end screw to close the needle holder and the needle holder, adjust the spacing to 1~2mm, and then fire to complete the fit. The stapler was removed, and the gastric stump was closed with XF suture, and the suture was not absorbed by the muscle layer. Then pyloric angioplasty. complication 1, bleeding. 2, duodenal stump or anastomotic leakage. 3, obstruction. 4, common bile duct injury. 5, the stomach ileum is inaccurate.

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