Esophagectomy and jejunal (colon) anastomosis

For patients with reflux esophagitis who require esophagectomy, the jejunum or colon segment can be used instead to rebuild the digestive tract. According to the observation of histamine stimulation, the jejunum or colon is more resistant to acid pepsin digestion than the duodenum in the new position. The transplanted jejunum not only retains its peristaltic form, but also retains the segmentality of the intestine. Contraction, similar to sphincter function. The intestinal wall is a smooth muscle tissue that does not fatigue and meets the physiological needs of patients with reflux esophagitis. Treatment of diseases: other malignant tumors of the esophagus Indication Esophagectomy and jejunal (colon) metastasis are applicable to: 1. Reflux esophagitis, esophageal stricture, shortening or ulceration, and severe adhesion and contraction of the fundus. 2. Recurrent reflux esophagitis after esophageal surgery. 3, severe esophageal stricture after treatment is ineffective. 4, can not exclude malignant or malignant tumors. Contraindications 1. Heart, lung, liver, kidney and other important organs and other systems can not withstand this operation. 2, had a history of repeated abdominal surgery, severe intra-abdominal adhesions, jejunum or colon can not be free. 3. Those suffering from intestinal diseases. Preoperative preparation 1. Intestinal preparation 3 days before the operation into the whole fluid, according to colon surgery for preoperative preparation. 2. If you have heart disease, take appropriate treatment. If you have lung disease, in addition to stop smoking, give sputum, anti-inflammatory and other treatment. 3, diet therapy and anti-acid therapy make reflux esophagitis in a stable state. 4, hemoglobin is too low, can be appropriate blood transfusion, in order to facilitate the healing of the incision. Surgical procedure 1, incision: chest and abdomen combined incision, the seventh intercostal chest. 2, pull out the esophagus: in the lower triangle of the esophagus free and pull out the lower esophagus, and free to the normal esophageal margin 2 ~ 3cm. 3, lower esophagus resection: the proximal end of the esophagus incision is closed with a condom, left for anastomosis. The end of the cardia is cut in two layers. 4, preparation of transplanted intestine (1) Free jejunal segment: Find the Treitz ligament. Select a 15-20 cm segment of the intestine at 20 to 30 cm from the flexor ligament. Try to block the edge of the vessel to be excised according to the blood vessel supply. Then, the intestine is clamped in the intestines at the place where it is expected to be cut off, and the blood circulation state of the transplanted intestine is observed for 15 minutes. If there is a problem with the circulation, it can be readjusted until the blood supply is good, and the intestine can be cut to warm. The saline gauze pad is protected for use. A viable end-to-end anastomosis (double layer) between the two ends of the intestine. Close the mesenteric incision. (2) Free colon segment: On the ascending, lateral or descending colon, a section of intestinal tube of 15-20 cm is selected, in which the middle colon artery, or the left colon artery, or the right colon artery is supplied with blood, which can be cut off after the colon is selected. The two ends are anastomosed, and the mesenteric incision must be sutured. 5, through the small omentum: the transplanted intestines are sent from the stomach through the small omentum capsule. 6, esophageal transplantation intestine segment anastomosis: the traditional double-layer anastomosis method, a full layer, and then a layer. However, in recent years, many scholars have used a layer of intermittent suture method, and the effect is also good. The inner diameter of the jejunum is similar to that of the esophagus, and the colon is much larger than the esophageal lumen. However, as long as the four-point anastomosis method is used, the esophagus and colon are divided into four points and sutured and knotted. So that there will be no missing needles or stitching pitches of different sizes. 7. Implantation of the intestine segment: The transplanted intestine segment below the esophageal-empty (junction) intestinal anastomosis is fixed with 2 to 3 needles on the connective tissue around the esophagus to reduce the anastomotic tension. 8, transplantation of the intestine segment of the fundus anastomosis: the stomach is another puncture hole, and the transplanted intestine segment with two layers. 9. Reconstruction of the diaphragmatic esophageal hiatus: The number of transplanted intestine segments is fixed at the edge of the hiatus esophageal hiatus. 10, the choice of transplanted intestine segment: the use of jejunum as a transplanted intestine segment is more convenient, but in recent years the use of colon as a transplanted intestine segment is also increasing, and some people use the transplant ileocecal intestine to reconstruct the esophagus to prevent reflux. 11. The thoracic cavity is placed in a drainage tube, and the incision is closed in layers. complication 1, esophageal transplantation intestinal anastomosis It is a serious complication. Once the anastomotic sputum is confirmed, the jejunostomy is given to maintain nutrition; the chest cavity is drained and suctioned with negative pressure; the nasogastric tube continues to drain the gastric juice, and the gastric juice that is drained is refilled into the jejunostomy every 2 hours to maintain digestive enzymes. Balanced with water and electrolytes, the so-called "three-tube therapy." If the anastomotic sputum is large and difficult to be cured by three-tube therapy, the esophagus should be re-extracted with esophagus, the esophagus should be re-synthesized, or the intestinal segment should be closed. The esophagus should be pulled out from the neck and the empyema should be treated first. In the second stage, the colon is replaced by the esophagus and the digestive tract is reconstructed. 2, pulmonary complications Pneumonia, atelectasis, and even lung abscesses can occur. 3, wound infection, empyema, underarm abscess Drainage, antibiotics, etc. should be treated.

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