Esophagocardium myometrial incision

Treatment of diseases: achalasia Indication Frequent seizures of sputum are not effective after strict medical treatment, and there is no significant effect of stenosis, or when you are unwilling to expand your sinus, you can have surgery regardless of age and stage of illness. Surgery often passes through the left thoracic cavity and can also be performed through the left upper abdominal incision. Preoperative preparation 1. Prepare routinely before general thoracic surgery. 2, 3 days before surgery, wash the esophagus once a night, after the injection of neomycin solution. 3. Place the stomach tube 1 hour before surgery. Surgical procedure The left thoracic approach to the left thoracic pathway is good for the esophagus, easy to operate, the incision of the muscular layer can be done thoroughly, and the damage of the esophageal vagus nerve can be avoided. In addition, if there is an esophageal diverticulum or hiatal hernia, it can be repaired at the same time. 1. The esophagus and the right lateral position of the cardia are exposed. After entering the chest through the left 7th ribbed bed or the 8th intercostal space, the lower ligament of the lung is cut. Retract the lower lobe of the lung, separate the lower part of the esophagus, take the soft rubber tube as the traction, and cut the diaphragmatic hole by 3 to 5 cm, so that the lower end of the esophagus and the cardia are fully exposed. The stenosis of the lower esophagus is above the cardia, and the esophagus above the stenosis is often enlarged, and the muscle layer is obviously hypertrophic. In the other part of the card, it is pulled around a hose. 2, cut the esophagus and cardia muscle layer to avoid the vagus nerve (especially the front branch) to avoid damage. Lift the two soft hoses and cut the longitudinal muscles of the outer layer of the esophagus. From the stenosis of the lower segment, a longitudinal incision is made with a sharp knife on the anterior wall of the esophagus, and the enlarged esophagus begins to descend to the plane. The deep circumflex muscles of this part are thicker, and can be cut into the submucosal layer at one place, and then placed under the muscle layer with a curved forceps or right angle pliers, and cut apart while separating, until the muscle layer loop fibers are completely cut. In order to completely cut the muscle layer of the cardia, the incision can be slightly extended to the upper part of the stomach, but not too long, can achieve the purpose, generally about 10cm in total length (the lower part of the esophagus accounts for about 8cm, the upper part of the stomach only accounts for 2cm. Too long, neither necessary nor the risk of cutting the gastric mucosa. 3, expand the mucosal bulging, put the finger on the opposite side of the esophageal incision, use a small gauze ball to clamp the muscle layer in the submucosal layer slightly to the sides to expand the area of the mucosal bulge. 4, suture the diaphragm and close the thoracic suture of the diaphragmatic incision, repair the esophageal hiatus should be appropriate, not too tight, so as not to affect the passage of food, and not too wide to prevent spasms. After the intercostal drainage tube is placed, the incision is sutured layer by layer. The drainage tube is generally kept for 1 to 2 days. If the mucosal damage has been sutured, the drainage time should be extended. The position of the esophagus through the abdomen is deep, and the abdominal incision is poorly exposed, and the operation is not easy to grasp; however, avoiding thoracotomy, reducing the damage, and convenient postoperative treatment, and covering the muscular layer incision of the esophagus and cardia with the stomach wall to protect the bulging Mucosa. 1, revealing the supine position of the cardia, the left back is high, take the left upper abdomen or the middle of the incision, up to the xiphoid. After the abdomen, the left triangular ligament of the liver was cut and the left lobe of the liver was pushed to the right. Reveal the cardia and the split hole. 2. Separate the lower end of the esophagus and cut the peritoneum at the cardia. Insert your finger into the lower mediastinum, bluntly separate the cardia and the lower end of the esophagus, pull down a soft hose or gauze, and pull the cardia and the lower end of the esophagus into the abdominal cavity. 3, incision of the esophageal muscle layer in the proximal anterior wall of the esophagus, the muscle layer longitudinally cut, directly to the submucosa. After the muscle fibers of the ring are completely cut, after the mucosa bulges, the lower mucous membrane of the muscle layer is peeled off to half of the circumference of the esophagus to ensure that the cardia is released. 4, covering the muscle layer incision bulging mucosa can not cover, but if the bottom of the stomach is covered by the muscle layer incision, it can protect the mucosa and reduce the chance of reflux. Firstly, the left margin of the incision of the anterior wall of the fundus and the left margin of the esophageal muscle incision are intermittently sutured, and then ligated one by one; then, in the suture line, 2 to 3 cm to the left, and then the gastric muscle layer A number of needles were sutured to the right margin of the esophageal muscular incision. Thus, the myometrial incision is covered by the anterior wall of the stomach. After the entire fundus is completely covered, the stomach is fixed on the diaphragm of the esophageal hiatus. 5, close the abdominal cavity is generally not drainage, but if there is serious pollution during the operation, the drainage strip is placed next to the cardia, and is taken out through the small incision under the xiphoid or the left abdominis. Finally, the abdominal wall incision is sutured layer by layer.

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