esophagus-gastric instrumentation anastomosis

The pleural apex is relatively fixed at the posterior, with three ligaments, the transverse pleural ligament descending from the 6th and 7th cervical transverse processes to the pleural apex, and the rib pleural ligament from the vertebral end of the first rib to the pleural apex, from the first chest The vertebral pleural ligament in the anterior aspect of the vertebral body to the inner pleura. The above three ligaments fix the posterior part of the pleura. The esophagus-gastric thoracic mechanical anastomosis refers to the end-to-side mechanical anastomosis of the proximal end of the esophagus and the "highest point" of the fundus. The left thoracotomy is performed from the left chest to the top of the left pleura. Treatment of diseases: esophageal cancer, other malignant tumors Indication The main surgical indication for esophageal-hepatic left thoracic mechanical anastomosis is malignant tumor of the middle esophagus (esophageal cancer), especially the esophageal cancer with the tumor at the level of the aortic arch and the esophagus with the upper edge of the tumor exceeding the aortic arch level of 1.5-2 cm. Upper cancer. For these two esophageal malignancies, the esophagus-gastric end-to-side anastomosis was performed manually on the thoracic top of the thoracic esophagus. Whether the surgery was exposed or the proximal end of the esophagus was anastomosed to the end of the stomach, it was very Difficult, and the length of esophagectomy is often limited; such as the use of esophagus-gastric neck and neck anastomosis, not only increases the surgical trauma and operation time, but also the incidence of postoperative esophageal-gastric anastomotic leakage can be as high as 25%. In order to solve these problems, domestic Zhang Xiaogong has used domestically produced GF-I tube-type digestive tract anastomat for more than 100 cases of esophagus-gastric left thoracic anastomosis since 1983. No postoperative intrathoracic esophagus-gastric anastomotic fistula occurred in 1 case. Pathological examination showed that the positive rate of proximal esophageal tumor cells was 7.1%. The main advantage of this surgical method is that it can increase the length of resection, greatly reduce the incidence of anastomotic leakage, improve the quality of surgery, and shorten the operation time. The main disadvantage is that the positive rate of residual tissue in the proximal end of the esophagus is relatively high. Therefore, if the upper edge of esophageal cancer exceeds the aortic arch level by more than 2 cm, esophageal-gastric neck anastomosis should be used. 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 1. Patients with high esophageal obstruction, wash the esophagus 3 days before surgery. 2. Oral esophageal anti-inflammatory drugs are taken after the hospital. 3. Strengthen nutrition and correct water and electrolyte disorders. 4. Colon transplants are prepared for colon cancer. Surgical procedure 1. Incision, human path, free esophagus, free stomach and other steps with esophageal surgery. 2. Cut the esophagus at the cardia, and use the Kocher clamp to clamp the end of the cardia. 3. At the upper edge of esophageal cancer 5 cm, the esophageal suture was wrapped around the esophagus with a thick wire. 4. Cut the esophagus 3 cm long under the suture, place the nail head in the esophageal lumen, and ligature the purse string. 5. Then use a thick thread to ligature one, cut the esophagus 0.5cm below the ligature, lift the stomach to the chest, and sew three needles at the posterior wall of the esophagus and the bottom of the stomach. 6. Remove the Kocher forceps, absorb the stomach contents, make a hole in the predetermined anastomosis of the fundus, and pull the center rod of the vascular clamp guide stapler out of the door. 7. Ligation of the back three stitches, insert the center rod into the stapler main body and fasten the fixing nut, so that the stomach bottom and the esophageal stump are completely close together, the handle is pressed, the firing is completed, and the stapling and cutting anastomosis is completed. 8. Embed the anterior wall of the stomach upwards at the lower end of the esophagus and suture the door. complication Intrathoracic anastomotic leakage and benign anastomotic stenosis are two major complications associated with mechanical anastomosis of the esophagus (intestine). According to domestic reports, the incidence of anastomotic leakage is 1.3% to 2% after mechanical anastomosis of the esophagus and stomach. The incidence of benign stenosis of anastomotic stoma is 0.9% to 22%, which occurs mostly from 6 months to 1 year after surgery. The size of the stapler has a certain relationship with the anastomotic stenosis, that is, the esophagogastric anastomosis is performed with a small stapler, and there is a tendency for benign anastomotic stricture after surgery. The anastomotic stenosis is treated by dilatation, and the caliber of the anastomosis can generally reach the normal size. In some patients, the narrow anastomosis can naturally expand to the normal range.

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