Gastroduodenal anastomosis

Applicable to cases of obvious stenosis, adhesion and severe deformation in the pyloric and duodenal bulbs. Except for not cutting the pyloric sphincter, the rest of the operation is the same as horseshoe-shaped incision pyloric angioplasty. 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 surgery to reduce gastric acid, and add gastric drainage (such as pyloricplasty, stomach twelve Intestinal anastomosis or gastrojejunostomy) to relieve retention of stomach contents. 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. The median incision in the upper abdomen or the right upper rectus abdominis incision. 2. Separate the duodenum and suture the posterior wall of the anastomosis: the peritoneum is cut open to the outside of the descending part of the duodenum, and the duodenum is separated to make the inner edge of the descending part of the duodenum close to the antrum of the antrum. And use the silk thread from the pylorus to make a row of sarcoplasmic layer intermittent suture, length 5 ~ 6cm, leaving a suture at both ends for traction. 3. Cut the stomach, intestinal wall, suture the inner layer of the wall: cut the stomach and duodenal muscle layer along the sides of the suture on the outer wall of the posterior wall. After suturing the submucosal blood vessels to stop bleeding, the mucosa was cut. After clearing the contents of the gastrointestinal cavity, the entire layer of the posterior wall of the anastomosis is sutured from the upper corner with the gut seam until the lower corner. 4. Stitching the inner wall and outer layer of the anterior wall: the same intestine is wound around the anterior wall, and the whole layer is continuously inverted and sutured to the upper corner, and is tied to the first needle gut in the cavity. Finally, the outer layer of the anterior wall was sutured as a discontinuous muscle layer with a silk thread.