Gastrojejunostomy

Generally for pre-colon gastrojejunostomy. This procedure is simple and short-lived, and is suitable for patients with unresectable gastric pyloric tumors and ulcerative pyloric obstruction who cannot tolerate resection. Treatment of diseases: gastric tumors, benign tumors of the stomach Indication 1. Pyloric obstruction caused by gastric cancer, the tumor has been fixed, can not be removed, can be used for gastric jejunostomy to relieve obstruction. 2. Gastric ulcer caused by pyloric obstruction, the condition is heavy, can not tolerate partial resection of the stomach, and because of such patients with low gastric acid, can be used for gastric jejunostomy. 3. Duodenal ulcer complicated with pyloric obstruction, the patient is in poor condition, can not tolerate the majority of gastric resection, can perform gastric vagus nerve cutting to reduce gastric acid, and add gastric drainage (such as pyloricplasty, stomach Duodenal anastomosis or gastrojejunostomy) to relieve retention of stomach contents. Preoperative preparation 1. Patients with pyloric obstruction, due to the retention of gastric contents, bacteria are easy to multiply, resulting in mucosal congestion and edema, which hinders the healing of postoperative anastomotic stoma. Fasting before surgery, gastric lavage before surgery, so that the stomach is drained as much as possible to reduce inflammation. 2. Appropriate fluid replacement, blood transfusion, and correction of water and electrolyte imbalance. 3. Before entering the operating room, the stomach tube should be taken out to evacuate the stomach contents to avoid vomiting during anesthesia, causing asphyxia and pulmonary complications. Surgical procedure 1. Position, incision: supine position, mid-abdominal incision or left upper trans-abdominal rectus incision. 2. Selection of jejunal anastomosis: laparotomy, to determine the patient is suitable for gastric jejunostomy, first lift the transverse colon, along the transverse mesenteric to find the duodenal suspensory ligament to confirm the beginning of the jejunum. A segment of the jejunum was selected, and at the two points 15 and 20 cm from the duodenal suspensory ligament, a needle was placed on the muscle wall of the intestinal wall with a silk thread as a marker for anastomosis. 3. Suture the mesenteric space: Tighten the transverse mesenteric membrane and the jejunum mesangial, and suture the two mesenteric sutures 4 to 5 needles from the base to the intestine side, and close the mesenteric space to prevent postoperative internal hemorrhoids. 4. Select the anastomosis of the anterior wall of the stomach: the pyloric obstruction of the ulcer disease, the anastomotic site can be selected in the vertical line across the pyloric incision, close to the front side wall of the large curvature of the stomach. For gastric pyloric tumors, the anastomotic site should be as far away as possible from the tumor, so as to avoid tumor invasion and short-term obstruction. After the anastomotic site is selected, the jejunum fistula with the suture mark is lifted from the front of the colon, and the stomach wall of the proposed anastomosis is swollen along the long axis (ie, the proximal end is on the left side and the distal end is on the right side). In the jejunum, the proximal mesenteric surface at both ends of the anastomosis (about 5 to 6 cm in length) is sewed together with the stomach wall, and the muscle layer traction line is sewed. 5. Stitch the posterior wall of the anastomosis: gauze protection on the circumference of the anastomosis and the back side of the anastomosis to avoid contamination of the abdominal cavity. First, the silky stomach and the intestinal wall (the outer layer of the posterior wall of the anastomosis) are sutured intermittently (or continuously). 6. Cut the stomach, intestinal wall, suture the posterior wall of the anastomosis: cut the gastric and intestinal wall muscles 0.5 cm along both sides of the suture, and suture the submucosal blood vessels (preferably with a little pulp muscle tissue) In order to avoid excessive valgus of the mucosa after being cut, the stomach and intestinal mucosa are cut open, and the contents of the stomach and intestine are sucked up with a suction device. From the distal angle, the inner wall of the posterior wall of the anastomosis is sutured. The first intestine is used to insert the needle from the intestinal lumen, penetrate the gastric cavity, and then return to the intestinal cavity from the gastric cavity to make a full-thick suture of the stomach and intestinal wall. Knot in the cavity, do not cut the thread. Use the same line to complete the back seam of the back wall. The margin is about 0.5 cm, the stitch length is about 0.8 cm, the seam is sewed to the proximal angle, and the proximal angle is completely inverted. 7. Stitch the anterior wall of the anastomosis: continue to use the same line along the anterior wall to replace the full-thick continuous inversion suture (Commell), wrap around to the beginning of the suture, and the ends of the combined gut are knotted in the cavity. At this point, the inner layer of the front wall is stitched. 8. Sewing the anterior wall of the anastomosis: After the outer layer of the anterior wall is sutured with the silk muscle layer, the anterior wall of the anastomosis is reinforced with 8-shaped or sacral suture. After the anastomosis is completed, check whether the intestinal fistula after the anastomosis is a jejunum, whether the length is appropriate, and whether there is distortion. Then, remove the gauze padding around the anastomosis and the posterior wall, wash your hands or change gloves after surgery, and use your fingers to detect the size of the anastomosis outside the stomach and intestinal wall. The anastomosis should be able to pass the 3 fingers, and the jejunum sputum input port and the output port can each pass the thumb. Finally, the abdominal cavity was inspected and the abdominal wall incision was sutured layer by layer.

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