Esophageal reconstruction anastomosis

Congenital esophageal atresia is a life-threatening severe deformity that should be treated early. Esophageal recanalization is also required after esophageal cancer resection to restore eating function. Treatment of diseases: congenital esophageal atresia and esophageal cancer Indication Esophageal resection and reconstruction of esophageal cancer and treatment of congenital stenosis of the esophagus. Contraindications In preterm infants who weigh less than 2 kg, cases with poor general condition or severe congenital malformations in other organs require staged orthodontic surgery. During the first operation, the esophageal tracheal fistula was cut and sutured, and a gastrostomy was performed through the abdominal incision to supply nutrients. A catheter is placed in the upper esophagus for continuous vacuum suction or cervical esophageal fistula to prevent aspiration pneumonia. After a few weeks, the body weight was increased to about 3 kg and the second stage of the operation was performed to anastomosis of the upper and lower esophagus. The upper and lower esophagus are blind ends. In patients without esophageal fistula, the length of the esophagus is often insufficient for end-to-end anastomosis. This type of congenital esophageal atresia also requires staged surgery. In the first operation, the proximal esophagus was taken out through the neck incision, and the blind end of the proximal esophagus was cut. The saliva was flowed to prevent overflow into the respiratory tract, and the abdominal incision was used for gastrostomy for feeding. When the child grows up to 3 to 4 years old, the second stage of colonic esophagectomy is performed. Preoperative preparation 1. Anyone who is suspected of this disease should fast, suck or mucus, give oxygen, keep warm, moisturize, correct dehydration, and apply blood products and antibiotics. Improvement in general conditions is conducive to surgery and its prognosis. 2. The key problem that needs to be solved before surgery is pneumonia, which is the result of inhalation of pharyngeal deposits and backflow of gastric juice into the tracheobronchial tree. 3, preoperative patients should always be in the vertical position, that is, using a semi-sitting position, and that it is continued until the anastomosis is healed. 4, try not to use a respirator before surgery, because it can cause gas to enter the gastrointestinal tract through the fistula, abdominal distension, diaphragmatic rise and even gastric perforation. However, some people advocate using a balloon tube to block the fistula to prevent the above complications. Surgical procedure The right thoracic posterior incision is usually used. The 4th or 5th ribs were removed through the ribbed bed or into the chest via the 4th intercostal incision. The azygous vein was cut in the thoracic cavity by pleural or incision of the pleura. Free the lower esophagus, wrap around with a thin band to facilitate the presentation of esophageal tracheal fistula on the posterior wall of the trachea. The fistula was cut at a distance of about 3 mm from the posterior wall of the trachea, and the incision of the posterior wall of the trachea was sutured transversely with a 5 to 0 suture of 5 to 0 stitches, and then covered with an adjacent pleura. Retaining a short segment of the fistula tissue prevents stenosis of the tracheal lumen when suturing the esophageal tracheal fistula. The operation of the lower esophagus should be gentle, and the free range should not be too long, so as not to affect the blood supply of the lower esophagus. The upper esophageal blood supply is more abundant, and should be sufficiently free to obtain a sufficient length to be anastomosed with the lower esophagus and reduce the anastomotic tension. A catheter is placed in the upper esophagus before surgery to help identify and free the upper esophagus. It is clear that the length of the esophagus in the upper and lower segments is sufficient for the end-to-end anastomosis. The apical portion of the lower esophageal blind end is removed, and the esophageal lumen is exposed. The muscle layer is peeled upward by 6 to 8 mm in the lower end of the upper esophageal wall. The mucosa of the upper esophageal wall is then anastomosed to the full layer of the lower esophageal wall. First, a needle traction suture is placed at each end of the anastomosis, and then the posterior wall and the anterior wall of the suture are intermittently sutured, and the muscle layer of the upper esophageal wall is then pulled down to the lower esophagus wall to cover the anastomosis. It is also possible not to peel off the muscle layer of the upper esophageal wall. Anastomosis was performed with the full layer of the upper and lower esophageal walls. Before the anterior wall of the anastomosis is completely sutured, a small catheter pre-operatively placed through the nose or the oral cavity is placed in the stomach through the anastomosis for postoperative decompression and feeding, or another gastrostomy for postoperative feeding. Food use. Colonic transplantation Esophageal reconstruction refers to the operation of the upper gastrointestinal tract by suturing and suturing the esophagus after partial esophagectomy. Esophageal resection for esophageal cancer and treatment of benign esophageal stricture. The left colon, the transverse colon, and the right colon are optional. After the severance, the vascular pedicle is pulled into the thoracic cavity in the direction of peristalsis or pulled to the neck through the anterior or sternal space of the sternum. The upper end is anastomosed to the end of the esophagus, and the lower end and the stomach end. - Side anastomosis. complication Surgical complications were anastomotic hernia and anastomotic stricture.

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