Esophagogastric anastomosis

1. Advanced esophageal cancer can not be surgically removed, nor can it be treated with radiation, and those with severe obstruction cannot eat. 2. Those who have severe dysphagia during radiotherapy. 3. Surgery revealed that the tumor could not be removed, and the patient had more serious obstruction. It is urgent to remove the obstruction and solve the diet to maintain the nutrition. Treatment of diseases: esophageal cancer, other malignant tumors Indication 1. Advanced esophageal cancer can not be surgically removed, nor can it be treated with radiation, and those with severe obstruction cannot eat. 2. Those who have severe dysphagia during radiotherapy. 3. Surgery revealed that the tumor could not be removed, and the patient had more serious obstruction. It is urgent to remove the obstruction and solve the diet to maintain the nutrition. Contraindications 1. Patients with severe heart and lung function. 2. The nutritional status is low, and the hemoglobin is lower than 6.0g/L. Preoperative preparation 1. People with malnutrition should be corrected before surgery. They can be intubated through central venous, supported by parenteral nutrition or treated with internal medicine or dilatation, so that they can enter the liquid food by mouth. 2. Patients with pulmonary complications should be treated appropriately. 3. Because the food is retained in the esophagus, the esophagus has different degrees of inflammation. The esophagus should be inserted into the stomach tube once a day for 3 days before surgery, and the antibiotic solution is injected after washing. Repeat 1 time before anesthesia to remove the accumulated secretions overnight and leave the stomach tube. Premedication should not be given to pills or tablets. Surgical procedure 1. The posterior lateral incision of the left chest enters the chest through the 7th or 7th intercostal space. 2. Cut the lower lung ligament until the level of the lower pulmonary vein, longitudinally cut the mediastinal pleura, free the lower end of the esophagus, take the gauze with the gauze, and explore the stenosis of the esophagus. 3. Cut the diaphragm along the hiatus of the esophagus, freely cut off the short gastric artery, so that the fundus can be lifted up. The esophageal muscle layer near the lower end of the esophagus and the muscle wall of the stomach wall are sutured intermittently, and the suture is not penetrated into the cavity. The stenosis of the esophageal and sacral sacs was completely cut at a width of 1 cm from the suture, thereby extending to both ends, and the incision was about 5 to 7 cm long. If the myometrial fibrosis is severe in the esophageal cardia, the esophagus can be cut over the stenosis area, so that the food after the anastomosis bypasses the cardia and directly enters the stomach. Make the same longitudinal incision in the stomach wall of the corresponding area of the esophagus. 4. The gastric and esophageal cutting edge is sutured from the midpoint of the incision to the ends. Turning to the front at the corners of both ends, the front wall is stitched by the inversion stitching method, and the stitches at both ends meet at the midpoint of the incision. The anterior wall is further sutured and sutured. The suture of this layer only passes through the esophageal muscle layer and the sarcolemma layer, and does not pass through the cavity. One stitch at each end of the slit is reinforced by a needle. 5. Or cut the entire layer of the esophageal stenosis and extend it to the bottom of the stomach into an arcuate incision. Before the esophagus is cut, a gauze can be ligated above the incision to prevent the esophageal contents from flowing out. A rubber sheathed intestinal forceps can also be placed under the fundus incision to prevent the contents of the stomach from flowing out. The posterior wall esophageal muscle layer and the gastric pulp muscle layer were sutured intermittently, and then the whole layer was sutured from the lower end of the esophageal incision. The anterior wall was sutured by the anterior wall and the anterior wall was used for the gastric mucosal and esophageal muscle layer. . 6. Reconstruct the esophageal hiatus, fix the diaphragm and the esophagus, around the stomach to prevent the occurrence of sputum. complication Gastroesophageal reflux and reflux esophagitis. If you have symptoms, you can take antacid treatment.