Gastrojejunostomy after colonic subtotal gastrectomy

Most of the stomach and duodenal ulcers can be cured by non-surgical treatment combined with traditional Chinese and Western medicine. Only when the following various conditions occur, surgery should be considered: 1. A large number of ulcers or repeated bleeding. 2. Scarring pyloric obstruction. 3. Acute perforation, not suitable for non-surgical treatment, and generally can tolerate gastrectomy. 4. Stomach ulcers and malignant changes. 5. Refractory ulcers, invalid treatment by internal medicine. Treatment of diseases: stomach cancer, stomach damage Indication Most of the stomach and duodenal ulcers can be cured by non-surgical treatment combined with traditional Chinese and Western medicine. Surgical treatment is only considered when the following conditions occur: 1. A large number of ulcers or repeated bleeding. 2. Scarring pyloric obstruction. 3. Acute perforation, not suitable for non-surgical treatment, and generally can tolerate gastrectomy. 4. Stomach ulcers and malignant changes. 5. Refractory ulcers, invalid treatment by internal medicine. Preoperative preparation 1. When there is no pyloric obstruction, change to liquid diet 1 day before surgery; when there is mild pyloric obstruction, change to liquid diet 2 to 3 days before surgery, fasting after noon on the 1st day before surgery; severe pyloric obstruction, Fasting should be done 2 to 3 days before surgery, but a small amount of water can be consumed. 2. Severe pyloric obstruction, the contents of the stomach have retention, 2 to 3 days before surgery, the stomach tube is placed every night to absorb the gastric retention, and the stomach should be washed with warm saline on the evening of 1st. 3. Patients with frequent pyloric obstruction and vomiting should check the binding of potassium, sodium, chlorine and carbon dioxide. If it is not normal, it should be corrected first. 4. Patients who are fasting before surgery should be supplied with heat by intravenous infusion to correct dehydration and electrolyte imbalance. 5. Enema with soapy water on the evening of the 1st day of surgery. 6. In the morning of the operation, the stomach tube is removed, and the gastric juice is taken out and left in the stomach. Surgical procedure This technique is to cut the transverse mesenteric membrane into a hole in the left avascular area of the middle cerebral artery, and take a segment of the jejunum at 5 to 10 cm from the duodenal suspensory ligament, which is raised upward through the transverse mesenteric opening, and the stomach is disabled. End-to-mouth anastomosis (small curved side of the gastric stump is not sutured, and the large curved side together with the jejunum). Finally, the transverse mesenteric incision was sutured and fixed to the stomach wall. 1. Stitching the posterior wall of the anastomosis: the pre-selected jejunal segment is lifted around the front of the transverse colon, close to the stomach stump, and ready for anastomosis. Roll up the stomach stump straight tongs upwards, expose the posterior wall, and suture the wall of the stomach at 0.5cm proximal to the jejunum wall for a row of pulp muscle layers, and remove the traction line as a marker. 2. Incision of the stomach wall and the jejunal wall: 0.5 cm on both sides of the suture of the muscle layer (seal of the posterior wall), the muscle layer of the posterior wall of the stomach is first cut, and the proximal end of the submucosal blood vessel of the stomach wall is sutured. . Each needle is placed next to the blood vessel, penetrates from the submucosal layer, crosses the blood vessel, and penetrates at the edge of the proximal muscle layer of the stomach. This way through a little muscle layer tissue, you can avoid excessive valgus of the mucosa after cutting off the clamped stump. The submucosal blood vessels of the anterior wall of the stomach were sutured by the same method. Then, the jejunal muscle layer was cut, and the submucosal blood vessels were sutured on both sides of the margin. Finally, the clamped stomach wall margin is cut off, and the jejunal mucosa is cut open to absorb the contents of the stomach and jejunum. 3. Complete gastric jejunal anastomosis: start with the 0 or 1 gut from the small curved side of the stomach, enter the needle from the intestine, pass through the whole layer of the posterior wall of the stomach and intestine, and then return to the stomach cavity. Needle to the ileum intestine cavity, knotted in the cavity fixed, the thread is not cut temporarily. The same intestine was used for full-layer suture stitching on the posterior wall of the gastric jejunal anastomosis. The margin was 0.5cm, the needle spacing was 0.8cm, and it was directly to the side of the large curvature of the stomach, and the large curved side angle of the stomach was inverted. Then, the large curved side angle is wound around the front wall of the anastomosis, and the whole layer of the front wall is continuously inverted and sutured to the small curved side angle, and knotted with the retained gut line. Finally, the suture was sutured in the anterior wall with a silk thread. At this point, the subtotal gastroenterostomy before the colon is completed. Check the anastomosis is smooth, no bleeding and residuals in the abdominal cavity, suture the abdominal wall incision layer by layer.

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