jejunostomy

Jejunostomy is a temporary partial ostomy that is often used for intubation. Treatment of diseases: duodenal fistula and duodenal fistula Indication 1. Pyloric obstruction, duodenal fistula, gastrointestinal anastomotic leakage, malnutrition. 2. The esophagus is narrow, can not eat, systemic malnutrition, and the stenosis can not be used to remove the surgery. 3. Obstructive jaundice caused by pancreatic head and ampulla cancer, can not be resected. When biliary drainage is unconditional, bile can be drained through the biliary tract and then returned to the intestine from jejunum. 4. Acute severe pancreatitis is estimated to be unable to eat in a short period of time, and can be supplemented with jejunostomy. Contraindications The age of the body is weak, the vital organs such as the heart and lungs are poor, and the surgery does not restore hope. Preoperative preparation Most patients are in poor condition and must be fully prepared before surgery. 1. Infusion, blood transfusion, correction of dehydration, acidosis and low plasma protein. 2. Intramuscular injection of vitamins b1, c, k. 3. Actively control infection and rational use of antibiotics. 4. Patients with intestinal obstruction or stomach or duodenal fistula should be placed with gastrointestinal decompression tube before operation. Surgical procedure 1. Position: supine position. 2. Incision: The left upper transabdominal rectus incision. 3. Looking for the jejunum: The assistant lifts the transverse colon; the surgeon proposes the jejunum from the root of the mesentery (the duodenal suspensory ligament in front of the left side of the spine), and selects the ostomy site 15 to 25 cm from the initial part. 4. Place the catheter: on the opposite side of the mesentery at the selected ostomy, use a silk thread to make a purse-string suture, about 1 to 1.5 cm in diameter. After the intestinal tube is protected with a saline gauze pad, a small hole is poked in the center of the purse-stitched suture with a sharp-edged knife to attract the contents of the intestine; then a distal end of the intestine is placed with a tip of 2 to 3 side holes. No. hose, the tip leads to the distal end of the jejunum 10~15cm, and the purse string is tightened and ligated. 5. Buried catheter: The catheter is placed on the proximal intestinal wall with the longitudinal axis of the intestine tube, and the muscle line is sutured along the two sides of the catheter with a thin line. The catheter and the purse suture are buried in the groove formed by the folding of the bilateral intestinal wall. Inside, the buried length needs to be about 5cm. 6. Fix the intestine: Pass the catheter through the omentum, and cover the omentum with the omentum, and poke the hose through the left upper abdomen. A few needles are fixed in the sarcolemma and parietal peritoneum of the ostomy tube, and the needle and the skin are fixed and stitched together. 7. Stitching: suture the abdominal wall incision layer by layer. complication infection.

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